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BOOKS 


BY 

CHARLOTTE  A.  AIKENS 


Primary  Studies  for  Nurses 

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Cloth,  $1.75  net.  Second  Edition, 


Clinical  Studies  for  Nurses 
i2mo  of  568  pages,  illustrated. 
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Hospital  Training-school  Methods 
and  the  Head  Nurse 
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Hospital  Management 
i2mo  of  488  pages,  illustrated. 

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Home  Nurse's  Hand-book 
i2mo  of  276  pages,  illustrated. 
Cloth,  $1.50  net. 


THE 


HOME  NURSE’S  HANDBOOK 

OF 

PRACTICAL  NURSING 


A MANUAL  FOR  USE  IN  HOME  NURSING  CLASSES  IN  YOUNG 
WOMEN’S  CHRISTIAN  ASSOCIATIONS.  IN  SCHOOLS  FOR  GIRLS 
AND  YOUNG  WOMEN,  AND  A WORKING  TEXT-BOOK  FOR  MOTHERS. 
“PRACTICAL”  NURSES,  TRAINED  ATTENDANTS,  AND  ALL  WHO 
HAVE  THE  RESPONSIBILITY  OF  THE  HOME  CARE  OF  THE  SICK 


BY 

CHARLOTTE  A.  AIKENS 

FORMERLY  DIRECTOR  OF  SIBLEY  MEMORIAL  HOSPITAL,  WASHINGTON,  D.  C.', 
FORMERLY  SUPERINTENDENT  OF  COLUMBIA  HOSPITAL,  PITTSBURGH,  AND 
OF  THE  IOWA  METHODIST  HOSPITAL,  DES  MOINES’,  AUTHOR  OF  ‘‘HOSPITAL 
TRAINING-SCHOOL  METHODS,”  “ PRIMARY  STUDIES  FOR  NURSES,”  “CLINI- 
CAL STUDIES  FOR  NURSES,”  AND  “HOSPITAL  MANAGEMENT” 


ILLUSTRATED 


PHILADELPHIA  AND  LONDON 

W.  B.  SAUNDERS  COMPANY 


1913 


Copyright,  1912,  by  W.  B.  Saunders  Company 


Reprinted  March,  1913,  and  June,  1913 


PRINTED  IN  AMERICA 


PRESS  OF 

W.  B.  SAUNDERS  COMPANY 
PHILADELPHIA 


^ouselhjJd  ^cj. 


Al  4-Vi 


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to 


Talk  Health.  The  dreary  never-changing  tale 
Of  mortal  maladies  is  worn  and  stale. 

You  cannot  charm  or  interest  or  please 
By  harping  on  that  minor  chord — disease. 

Whatever  the  weather  may  be’^  says  he, 
‘^Whatever  the  weather  may  be, 

Its  the  songs  you  sing  and  the  smiles  you  wear. 
That’s  a-making  the  sun  shine  everywhere.’’ 


Riley, 


Cl 


s: 


CO 

<N 


PREFACE 


By  the  most  fundamental  of  all  laws,  women  are  the 
nurses  of  the  world.  Few,  if  any  women,  escape  the 
responsibility  of  the  care  of  some  sick  or  helpless  one. 
All  women  have  the  responsibility  of  the  nursing  of 
health  in  the  home,  or  the  prevention  of  disease.  A 
lamentable  fact  to  consider  is  that  so  many  ailments, 
which  are,  in  the  early  stages  apparently  trifling,  readily 
curable,  result  fatally  because  of  ignorance  and  lack  of 
proper  home  nursing.  Thousands  of  children  and 
youths  and  others  in  early  middle  life  go  to  premature 
graves  every  year  who  need  not  have  died  had  their 
mothers  or  wives  known  the  barest  essentials  of  proper 
care  of  the  sick.  The  most  ardent  love,  the  most  untiring 
efforts,  nor  the  best  of  intentions,  will  not  undo  the 
results  of  ignorance. 

This  little  volume  deals  with  home  nursing  as  distinct 
from  the  more  elaborate  technic  of  hospital  practice.  It 
is  the  result  of  years  of  experience  in  hospital  work  where 
one  sees  as  nowhere  else,  the  results  of  maternal  ignorance 
of  the  laws  of  health  and  sanitary  living,  ignorance  of  the 
rudiments  of  proper  management  when  signs  of  illness 
manifest  themselves  in  the  home  circle.  It  is  designed  as 
a guide  to  the  home  girl  or  woman  who  seriously  desires 
to  fit  herself  to  do  her  best  for  the  health  of  her  own 
family,  and  as  a working  textbook  for  the  ^^practicaF^ 
nurse  or  trained  attendant  who  desires  to  be  a useful 
helper  to  the  physician  in  the  home  sickroom. 

Special  attention  has  been  given  to  the  care  of  babies 
and  maternity  nursing.  Those  who  lead  in  advance 
movements  for  public  welfare  are  more  and  more  em- 
phasizing the  thought  that  since  every  girl  naturally  and 
instinctively  looks  toward  motherhood,  instruction  in 
baby  hygiene  is  her  right,  and  no  motives  of  prudery 
should  longer  deprive  her  of  this  instruction.  It  is  being 
recognized  that  an  educational  scheme  which  leaves 
infant  and  child  hygiene  entirely  out,  which  leaves  young 

7 


8 


PREFACE 


mothers  to  learn  wholly  by  experiment  and  at  the  risk 
of  the  baby^s  life,  how  to  care  for  the  babies  of  the  state, 
is  not  calculated  to  produce  the  best  results  to  the  child, 
the  home,  nor  the  nation.  How  to  conserve  this  most 
important  of  all  national  resources  is  a practical  problem 
in  the  solution  of  which  all  educational  institutions  which 
have  to  do  with  growing  girls  and  young  women  should 
share. 

The  first  step  toward  obtaining  a better,  more  intel- 
ligent motherhood  for  American  babies,  is  to  train  the 
older  girls  and  the  young  women  in  the  elements  of  baby 
hygiene  and  proper  home  care  of  the  sick.  To  leave  the 
fate  of  the  new  generation  to  unreasoning  chance  or 
impulse,  to  neglect  to  give  the  mothers  of  the  coming 
generation  a word  of  instruction  about  the  most  impor- 
tant duty  they  will  have  to  perform,  is  not  compatible 
with  American  common  sense,  even  if  custom  has  for 
years  sanctioned  it. 

In  preparing  this  manual  it  has  been  assumed  that 
students  have  had  some  previous  instruction  in  the 
elements  of  physiology  and  general  hygiene,  also  that  the 
theoretic  instruction  will  be  accompanied  with  practical 
demonstration  in  how  to  do  the  duties  mentioned  in  each 
chapter.  The  studies  have  been  arranged  so  as  to  be 
easily  grasped  by  the  average  girl  or  woman  who  is  able 
to  master  sixth  or  seventh  grade  school  work.  The 
practical  demonstrations  mentioned  at  the  beginning 
of  each  chapter  are  only  suggestive.  The  instruction 
should  be  given  preferably  by  a physician  or  trained 
nurse,  and  the  resourceful  instructor  will  be  able  to 
make  many  additions  to  the  list  of  methods  which 
may  profitably  be  demonstrated  before  a class. 

The  illustrations  have  been  chosen  with  a view  to  being 
helpful  especially  to  the  home  woman  who  uses  the  book 
without  the  aid  of  a teacher.  Special  thanks  are  due 
Messrs.  Meinecke  and  Co.,  of  New  York  City  for  loaning 
several  electrotypes  illustrating  sickroom  appliances. 

Charlotte  A.  Aikens. 


Detroit,  Mich. 


CONTENTS 


PAGE 

CHAPTER  I. 

How  TO  Keep  Well  11 

CHAPTER  II. 

The  Sick-room  and  Nurse  21 

CHAPTER  III. 

Things  to  Have  Ready  for  Sickness . 30 

CHAPTER  IV. 

The  Bed  and  Bedmaking 38 

CHAPTER  V. 

The  Personal  Care  of  the  Invalid  ..........  47 

CHAPTER  VI. 

The  Personal  Care  of  the  Invalid  (continued) 56 

CHAPTER  VII. 

Feeding  the  Sick 64 

CHAPTER  VIII. 

Feeding  the  Sick  (continued) 76 

CHAPTER  IX. 

Symptoms  of  Sickness 84 

CHAPTER  X. 

Symptoms  of  Sickness  (continued) 91 

CHAPTER  XI. 

Baths  and  Packs  98 

CHAPTER  XII. 

Home  Treatments  and  How  to  Give  Them 104 

9 


10 


CONTENTS 


CHAPTER  XIII. 

PAGE 

Home  Treatments  and  How  to  Give  Them  (continued)  . 112 

CHAPTER  XIV/ 

The  Giving  of  Medicines 118 

CHAPTER  XV. 

Everyday  Care  of  the  Baby 128 

CHAPTER  XVI. 

Everyday  Care  of  the  Baby  (continued) 135 

CHAPTER  XVII. 

The  Bottle-fed  Baby 142 

CHAPTER  XVIII. 

Household  Disinfectants,  and  How  to  Use  Them  . . . 151 

CHAPTER  XIX. 

Communicable  Diseases  in  the  Home 159 

CHAPTER  XX. 

A Lesson  on  Bandaging 170 

CHAPTER  XXI. 

Accidents  and  Emergencies 179 

CHAPTER  XXII. 

Maternity  Nursing 197 

CHAPTER  XXIII. 

Maternity  Nursing  after  the  Birth 208 

CHAPTER  XXIV. 

Practical  Nursing  Points  in  Special  Diseases  and 

Conditions  224 

CHAPTER  XXV. 

Invalid  Cookery;  Selected  Recipes 253 


Index 


271 


THE  HOME  NURSES’  HAND-BOOK 


CHAPTER  I. 

HOW  TO  KEEP  WELL. 

Demonstration  and  Practice  Work. — Plan  a meal  containing  six 
articles  of  food,  and  show  that  these  foods  contain  all  the  material 
necessary  for  healthy  growth  and  repair  of  the  body.  Explain 
charts  illustrating  disease  germs  and  show  how  some  grow  in 
clusters  like  grapes,  others  in  spiral  form,  etc. 

Those  who  wish  to  have  strong  healthy  bodies  must 
early  learn  that  there  are  laws  of  health  which  must  be 
known  and  observed,  and  that  sickness  follows  the 
continued  violation  of  these  rules.  These  health  laws 
have  been  likened  to  a chain  of  defence  consisting  of 
several  links.  Important  links  in  the  health  chain  are: 
Plenty  of  clean  air  to  breathe  day  and  night;  proper 
food  properly  prepared  and  eaten;  water  free  from  im- 
purities; a uniform  degree  of  sunshine  and  heat — air 
neither  too  hot  nor  too  cold;  exercise,  rest,  and  plenty 
of  sleep;  the  body  must  be  kept  clean;  the  poisonous 
waste  products  of  the  body  must  be  thrown  off;  disease 
germs  must,  as  far  as  possible,  be  prevented  from  getting 
into  the  body. 

The  body  in  many  respects  resembles  an  engine  needing 
to  be  constantly  supplied  with  material  from  which 
heat  comes,  from  which  new  tissues  are  formed  and  power 
to  work  or  move  around  is  produced.  If  an  engine  is  to 
do  good  work,  the  flues  must  be  kept  clean;  it  must  be 
well  oiled;  it  must  not  be  allowed  to  become  clogged  with 

11 


12 


HOME  nurse's  hand-book 


ashes  and  waste  matter;  the  amount  of  fuel  must  be 
regulated;  the  draughts  must  be  properly  adjusted. 
In  a general  way  this  is  true  of  the  human  body. 

Air  is  the  most  immediate  necessary  of  life.  About 
one-fifth  of  the  air  is  oxygen. 

The  blood  is  purified  by  its  contact  with  the  oxygen  in 
the  lungs;  hence  it  follows  that  unless  oxygen  is  supplied, 
the  blood  must  retain  the  impurities  it  has  accumulated 
in  its  circulation  through  the  body,  and  the  whole  system 
suffers. 

Impure  Air  Diseases, — A large  proportion  of  sickness 
comes  from  breathing  impure  air — air  which  is  loaded 
with  dust,  poisonous  gases,  smoke,  or  the  exhalations  of 
the  body;  and  air  which  is  infected  with  disease  germs. 
Among  the  common  impure  air  diseases  are  pneumonia, 
bronchitis,  influenza,  and  tuberculosis.  Those  who 
constantly  breathe  bad  air,  weaken  their  bodies  so  that 
they  contract  other  diseases  very  easily.  The  bad  air 
in  homes  is  directly  responsible  for  a great  deal  of  the 
colds,  sore  throats,  coughs,  tonsillitis,  etc.,  which  afflict 
some  families  every  winter. 

Cold  air  is  healthy,  stimulating  and  curative  in  its 
effects,  and  in  every  living  and  sleeping  room  there 
should  be  some  means  of  escape  provided  for  the  bad 
air  and  of  entrance  for  fresh  clean  air.  The  belief  that 
night  air  is  injurious  is  a delusion.  It  ic,  as  a rule,  freer 
from  dust  than  the  air  breathed  during  the  day. 

Sunshine  and  light  are  also  necessary  if  sound  bodies 
and  robust  health  are  to  be  maintained.  It  is  hard  to 
explain  how  the  sun  influences  the  health,  but  it  is  well 
known  that  it  does  so.  And  this  is  true  of  plants  as  well  as 
of  the  animal  creation.  For  illustration:  if  one  geranium 
plant  is  placed  where  the  sun  may  shine  on  it  freely, 
and  another  is  placed  in  a dark  room  or  cellar,  there  will 
soon  be  observed  a great  difference  in  the  color  of  the 
leaves  and  the  general  growth  of  the  plants.  A similar 
difference  will  be  seen  by  careful  observers  in  children 
who  are  housed  in  dull  dark  rooms,  as  compared  to 


HOW  TO  KEEP  WELL 


13 


those  who  have  plenty  of  light  and  sunshine  in  and  about 
their  homes. 

Rest,  Recreation  and  Exercise. — Every  one  knows 
the  saying  about  ^^all  work  and  no  play/^  but  people 
do  not  always  remember  that  if  their  ^^play is  really  to 
do  them  good,  it  should  be  as  great  a change  from  their 
work  as  possible,  and  should  also  give  their  bodies 
some  exercise.  ^^It  is  not  a good  thing  when  one’s  only 
form  of  recreation  is  to  go  to  crowded  places  of  amuse- 
ment, where,  perhaps,  the  ventilation  is  bad,  and  they 
are  breathing  air  which  is  so  stale  as  to  be  poisonous. 
Very  much  depends  on  what  anyone’s  everyday  work  is, 
for  the  best  recreation  is  something  that  is  a complete 
change  from  that.  As  a rule,  people  use  one  part  of 
their  bodies  far  more  than  another  in  their  work;  for 
instance,  those  whose  work  is  typewriting  or  machining, 
sit  still,  and  chiefly  use  their  hands  and  their  brains, 
while  others  may  be  walking  or  standing  or  doing  work 
in  which  they  use  their  muscles  a great  deal.  It  is 
well  to  let  our  recreation  give  the  unused  part  something 
to  do,  so  as  to  try  to  have  every  part  of  the  body  used 
equally  and  have  its  fair  share  of  exercise.  If  the  work 
means  sitting  still  indoors,  the  recreation  should  be 
something  in  the  way  of  outdoor  exercise,  while  for  any- 
one who  works  out  of  doors,  or  is  constantly  moving 
about,  that  is  not  so  necessary.  People  who  spend  their 
time  in  workrooms  and  factories  where  the  air  is  often 
bad,  should  make  a great  point  of  getting  some  exercise 
in  the  open  air,  and  though  they  may  be  feeling  almost 
too  tired  to  do  anything  except  go  home  and  rest,  it 
is  worth  while  to  make  the  effort,  for  the  sake  of  the  good 
it  will  do  them.” 

Proper  food,  properly  prepared  and  eaten,  is  necessary 
to  build  up  the  body  during  the  growing  period,  to  repair 
it,  to  furnish  heat,  and  strength  to  work.  The  foods 
eaten  should  be  chosen  so  as  to  supply  the  different  ele- 
ments the  body  needs  for  all  these  purposes. 

Among  the  foods  needed  for  building  up  and  repairing 


14 


HOME  NURSE^S  HAND-BOOK 


the  body  are:  milk,  eggs,  lean  meat,  bread,  oatmeal, 
and  corn. 

Foods  needed  to  produce  heat  and  strength  are: 
starches  found  in  potatoes,  rice,  breakfast  foods,  etc.; 
sugar,  honey,  and  fats,  such  as  butter  and  the  fat  of  meats. 
A certain  amount  of  lime  and  other  mineral  matter  is 
necessary  to  provide  material  for  bone  making  and 
repair,  and  for  the  teeth.  These  elements  are  found  in 
water,  fruits,  and  green  vegetables. 

Chewing  the  food  thoroughly  is  one  of  the  important 
essentials  of  health.  Hence  in  keeping  well,  the  teeth 
have  a very  important  work  to  do.  Food  that  is  not 
properly  chewed  is  harder  to  digest,  and  the  stomach 
often  refuses  to  do  the  double  duty  forced  on  it  by  half 
chewed  food.  This  is  the  cause  of  much  of  the  dys- 
pepsia and  other  digestive  trouble  that  is  so  common. 

Overeating. — Eating  more  food  than  the  body  needs, 
or  than  the  organs  can  dispose  of,  is  a fruitful  cause  of 
sickness.  The  system  gets  clogged  up  with  waste  prod- 
ucts, and  sooner  or  later  some  organ  is  going  to  weaken 
because  of  the  overwork  it  is  forced  to  do. 

Eating  the  wrong  food,  or  not  enough  of  any  one  class 
of  food,  or  food  improperly  prepared,  all  affect  injuriously 
the  human  structure  and  make  it  impossible  to  keep 
entirely  well. 

Plenty  of  water  is  needed  to  supply  the  fluids  of  the 
body  and  to  help  wash  away  the  waste  or  broken-down 
tissues.  Neglect  to  drink  enough  water  every  day, 
summer  and  winter,  helps  to  cause  sickness. 

Cleanliness  is  one  of  the  greatest  aids  to  health.  Dirt 
and  disease  go  hand  in  hand. 

The  mouth  and  the  way  in  which  it  is  cared  for  (or 
neglected)  has  a more  direct  bearing  on  health  than 
most  people  believe.  It  is  the  gateway  to  the  body. 
Leading  from  it  are  seven  openings — two  to  the  nose 
and  upper  air  passages,  one  to  the  stomach,  one  to  the 
windpipe,  and  thence  to  the  bronchial  tubes  and  lungs, 
two  tubes  lead  from  the  throat  to  the  ear,  and  one  opening 


HOW  TO  KEEP  WELL 


15 


leads  to  the  outer  world.  Therefore  the  importance  of 
keeping  the  mouth  clean,  of  careful  cleansing  of  the 
throat  when  acute  diseases  are  prevalent,  and  of  keeping 
the  teeth  in  good  order,  needs  no  argument.  Decaying 
teeth  are  a breeding  place  for  germs  and  favor  the 
development  of  germ  diseases.  Poor  teeth  mean  poor 
mastication  of  food,  and  consequently  poor  digestion. 

Friends  and  Enemies  of  Health. — While  much  has  been 
said  and  written  about  germs  or  bacteria  or  microbes 
as  causes  of  disease,  there  is  still 
much  misunderstanding  as  to 
these  tiny  forces  which  exert 
such  a powerful  influence  in  favor 
of  or  against  health.  The  misun- 
derstanding and  indifference  arise 
partly  from  the  fact  that  the 
germs  are  so  small  that  they  can- 
not be  seen  by  the  eye  without 
the  aid  of  a microscope. 

A germ  is  much  like  a very  tiny 
seed,  and  like  other  seeds  must  be 
planted  in  a soil  that  is  suitable  before  it  will  grow. 
Pansy  seeds  if  planted  in  dry  sand  or  ashes  would  not 
grow.  They  might  retain  their  power  to  germinate, 
but  they  would  not  take  root  in  such  a soil.  If  a 
very  poor  soil  of  dry  clay  were  provided  for  the  seeds 
they  would  probably  grow  a little,  but  the  chances  are 
the  life  of  the  plant  would  be  short.  If  good  suitable 
soil  and  conditions  were  provided  to  receive  the  seeds 
there  would  be  fine  healthy  plants  as  a result. 

The  body  is  the  soil  in  which  the  seeds  or  germs  of 
disease  develop.  There  are  natural  elements  in  the  body 
intended  to  overcome  or  kill  the  germs  of  disease  which 
enter  the  body.  When  the  blood  is  pure,  and  the  organs 
sound  and  healthy,  doing  their  work  properly,  the  germs 
which  gain  entrance  will  find  stony  ground’^  unsuit- 
able for  their  growth,  and  will  be  quickly  cast  out  or 
overcome.  But  if  the  body  is  weakened  from  any 


Fig.  l.-yMicrococcus  men- 
ingitidis  cerebrospinalis 
( X 1000) . {Lehmann  and 
Neumann.) 


16 


HOME  NURSE^S  HAND-BOOK 


cause,  or  the  blood  is  deficient  in  quantity,  or  poor  in 
quality,  there  will  be  less  resistance  to  the  growth  of  the 
seeds  of  disease,  and  they  will  more  readily  take  root 
and  cause  sickness. 

The  germs  of  diseases  of  various  kinds  are  always 
found  in  the  air.  They  are  often 
carried  in  food  and  water.  They 
flourish  wherever  dirt  is  allowed 
to  collect,  and  in  dark  damp  or 
unsanitary  surroundings,  and 
are  readily  carried  about  in  the 
air  by  means  of  floating  dust,  or 
clothing,  dishes,  etc. 

Disease  germs  are  different 
from  each  other  in  many  ways, 
just  as  other  seeds  are  different 
in  appearance  and  general  char- 
acteristics; some  bodies  are  suit- 
able soil  for  one  kind  of  germ, 

and  very  poor  soil  for  other 

germs.  By  means  of  the  micro- 
scope and  other  methods  of  in- 
vestigation, medical  men  are 
able  to  determine  the  kind  of 
disease  that  is  developing  by 

finding  out  the  kind  of  germ. 

For  instance,  a case  of  severe 

sore  throat  may  or  may  not  be 

diphtheria.  If  diphtheria,  in 

order  to  protect  others,  the  sick 
one  should  be  promptly  isolated.  The  matter  can  be 

decided  by  a scientific  examination  of  a swab  which 

has  been  used  to  brush  the  throat.  Children  are  much 
more  lial)le  to  develop  sickness  on  exposure  of  disease 
germs  than  others,  and  for  that  reason  greater  precau- 
tions are  needed  in  their  case  than  with  adults. 

The  Spread  of  Disease. — Among  the  common  methods 
by  which  disease  germs  are  spread  are: 


Fig.  2. — Bacillus  tubercu- 
losis; glycerin  agar-agar  cul- 
ture, several  months  old 
(jOurtis), 


HOW  TO  KEEP  WELL 


17 


1.  By  means  of  dust  the  germs  may,  when  dry,  be 
distributed  through  the  air. 

2.  By  being  washed  over  the  surface  of  the  earth  or 
by  filtering  through  the  ground  they  may  infect  the 
water  supply.  (It  is  claimed,  however,  that  disease 
germs  are  rarely  found  lower  in  the  earth  than  5 or  6 feet, 
certain  elements  in  the  earth  having  the  power  to  destroy 
them  in  course  of  time.) 

3.  By  means  of  flies  they  may  be  deposited  on  food 
or  drink. 

4.  By  means  of  clothing,  unclean  utensils,  soiled 
boots,  or  animals. 

5.  By  direct  contact  through  handling. 

6.  By  means  of  mosquitoes. 

How  Disease  Germs  Enter  the  Body. — ^Disease  germs 
may  enter  the  body  through  the  mouth,  the  nose, 
through  the  skin,  through  wounds,  and  through  any 
of  the  cavities  of  the  body  which  have  an  external 
opening. 

Communicable  diseases  are  those  caused  by  disease 
germs,  and  which  are  capable  of  being  communicated 
from  one  person  to  another.  A false  sense  of  security  is 
often  observed,  when  for  instance  a mild  case  of  measles 
or  scarlet  fever  exists.  There  is  a feeling  that  there  is 
less  danger  of  infection,  because  it  is  not  a severe  attack, 
while  it  is  forgotten  that  the  severity  of  the  disease  de- 
pends greatly  on  the  soil  in  which  the  seeds  or  germs  of 
disease  are  sown.  One  person  may  have  a mild  attack  of 
a certain  disease  while  another  to  whom  the  disease  was 
transmitted  may  have  a serious  or  fatal  attack  because 
the  body  was  '^run  down’^  or  in  poor  condition  to  resist 
disease. 

Disease  germs  are  always  destructive.  Their  work  is 
to  tear  down  and  feed  on  the  living  tissues  in  the  body, 
and  to  produce  within  it  substances  poisonous  to  the 
parts  which  are  attacked  by  them. 

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Good  Germs, — All  germs  are  not  disease  germs.  The 
majority  of  germs  are  good  germs,  or  germs  which  are 
friendly  to  life  and  health.  Good  germs  feed  on  dead 
leaves,  grass,  and  waste  matter,  and  render  harmless 
many  objects  which  would  otherwise  be  destructive  to 
life.  Animal  life  is  dependent  on  vegetable  life.  Vege- 
table life  is  dependent  on  certain  qualities  in  the  soil,  each 
blade  of  grass  and  plant  appropriating  from  the  elements 
of  the  soil  the  material  needed  for  its  growth.  If  the 
earth  is  to  continue  to  produce  the  vegetation  on  which 
animal  life  depends,  the  elements  drawn  from  it  by  plants 
must  in  some  way  be  restored  to  it.  The  restoring  of 
these  elements  is  dependent  on  these  little  invisible 
friends,  the  germs.  Through  their  increasing  activity 
dead  plant  and  animal  matter  is  disintegrated,  broken  up 
into  simple  elements,  to  be  again  absorbed  by  the  earth 
and  again  used  to  produce  vegetation. 

Disinfectants  are  substances  which  have  the  power 
to  destroy  disease  germs. 

Heat  is  the  most  effectual  of  all  methods  used  in  de- 
stroying such  germs  and  rendering  objects  safe  after 
being  infected. 

Boiling  will  destroy  practically  all  disease  germs  in  a 
very  few  minutes.  A temperature  below  boiling-point 
is  sufficient  to  destroy  most  of  them  in  a half  hour. 
There  are  some  few  diseases  in  which  the  spores  or 
seeds  of  germs  are  hard  to  destroy.  In  such  cases  boil- 
ing for  two  hours  is  needed.  The  germs  of  cholera, 
typhoid  fever,  dysentery,  pneumonia,  diphtheria,  ery- 
sipelas, influenza,  cerebro-spinal  meningitis,  tuberculosis 
and  pus-producing  germs  do  not  have  spores  and  are 
readily  destroyed  by  ordinary  methods  of  disinfection, 
intelligently  used. 

M^hen  dnnking  water  is  suspected  to  contain  disease 
germs,  it  is  never  wise  to  depend  on  filters  to  cleanse  it. 
A glass  of  water  that  is  clear  as  crystal  may  contain 
enough  disease  germs  to  infect  a whole  village.  It  is 
always  safer  to  boil  and  cool  the  water  before  drinking 


HOW  TO  KEEP  WELL 


19 


it.  Ice  which  contained  typhoid  fever  germs  has  been 
responsible  for  some  of  the  most  serious  epidemics  of 
the  country.  Green  vegetables  or  fruits  washed  in 
impure  water^  or  in  water  containing  disease  germs,  may 
as  readily  convey  the  infection  into  the  system  as  drink- 
ing water.  Infected  ice  may  be  put  in  pure  water  to 
cool  it  and  thereby  carry  disease  into  the  body. 

Chemical  disinfectants  are  used  for  disinfection  of 
such  substances  as  cannot  be  purified  by  heat.  Car- 
bolic acid,  and  chloride  of  lime  are  illustrations  of  chemi- 
cal disinfectants. 

Ordinary  cleanliness^  dryness  and  sunshine  are  import- 
ant aids  in  the  work  of  disinfection  as  well  as  in  the 
prevention  of  disease.  Experiments  have  shown  that 
few  disease  germs  can  live  many  hours  if  exposed  to  the 
direct  effect  of  the  rays  of  the  sun.  Dryness  also  is 
unfavorable  to  the  development  of  disease  germs.  Hence 
dryness  and  sunshine  combined,  are  two  powerful  weap- 
ons with  which  to  fight  disease. 

Points  to  be  Remembered. — Those  who  wish  to  be 
well  must  observe  the  laws  of  health. 

Clean  air,  proper  food,  pure  water,  plenty  of  sleep, 
rest,  and  exercise  and  general  body  cleanliness,  are  the 
important  essentials  to  health. 

Give  the  body  plenty  of  water,  in  summer  and  winter 
to  keep  the  machinery  lubricated. 

The  lungs,  skin,  bowels  and  kidneys  are  the  sewers 
of  the  body.  It  is  important  to  keep  each  of  them  in 
good  working  order  if  waste  products  of  the  body  are 
not  allowed  to  accumulate. 

A large  proportion  of  sickness  in  cold  weather  comes 
from  impure  air. 

Cold  air  is  one  of  the  best  remedies  in  some  diseases. 

Sunshine  and  light  are  necessary  if  sound  health  is  to 
be  maintained. 

Properly  balanced  foods  are  essential  to  sound  robust 
bodies. 

Cleanliness  of  the  mouth  has  a direct  bearing  on  health 


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When  food  is  imperfectly  chewed  it  throws  an  extra 
burden  on  the  digestive  organs. 

To  keep  the  body  in  sound  condition  is  one  of  the  best 
ways  to  guard  against  communicable  diseases. 

Children  are  much  more  liable  to  develop  germ  diseases 
than  adults. 

A mild  case  of  scarlet  fever  is  quite  sufficient  to  cause 
a severe  case  in  another  person. 

Filters  are  not  to  be  depended  on  for  safety  if  the 
water  supply  is  suspected  to  contain  disease  germs. 

Infected  ice  may  easily  infect  pure  drinking  water 
if  put  into  it. 


REVIEW  QUESTIONS. 

1.  Name  eight  rules  of  health  that  must  be  observed  by  those 
who  desire  to  keep  well. 

2.  Show  how  the  body  resembles  an  engine. 

3.  What  effect  does  pure  air  have  on  the  blood?  What  sort  of 
blood  may  we  expect  to  have  if  we  breathe  bad  air  constantly  ? 

4.  Name  some  diseases  which  are  mainly  due  to  impure  air. 

5.  What  effect  do  sunshine  and  light  have  on  plants?  On 

children  ? ^ 

6.  For  what  different  purposes  is  food  needed  in  the  body? 

7.  Name  some  foods  which  you  would  class  as  body-building 
foods. 

8.  Mention  some  foods  which  help  to  keep  the  body  warm  and 
produce  strength. 

9.  Why  is  lime  or  mineral  matter  needed  in  the  body?  In  what 
foods  would  you  expect  to  find  it? 

10.  Where  are  disease  germs  found? 

1 1 . How  are  diseases  spread  ? 

12.  Mention  several  ways  in  which  disease  germs  may  enter  the 
body. 

13.  What  useful  work  do  good  germs  perform? 

14.  What  would  happen  if  all  good  germs  ceased  their  work? 

15.  What  is  a disinfectant? 

1 0.  Mention  several  ways  by  which  disease  germs  may  be  destroyed. 

17.  What  effect  does  sunshine  have  on  disease  germs? 

18.  How  would  you  render  drinking  water  safe  that  was  suspected 
to  be  impure? 

19.  What  precautions  would  you  use  in  preparing  green  vegetables 
for  the  table  when  the  water  had  been  j)ronounced  unsafe  ? 

20.  Is,  or  is  not,  dryness  favorable  to  the  growth  of  disease  germs  ? 


CHAPTER  II. 


THE  SICK-ROOM  AND  NURSE. 

Demonstration  and  Practice  Work. — ^Proper  methods  of  sweeping 
and  dusting  and  arrangements  for  ventilation. 

A very  simple  and  trifling  ailment  may  develop  into  a 
more  serious  one  through  lack  of  proper  care.  In  most 
cases  of  illness,  rest  in  bed  is  an  important  part  of  the 
measures  used  to  win  back  health.  On  the  proper  care 
and  management  of  the^room,  bed,  and  general  surround- 
ings, the  comfort  and  welfare  of  the  sick  one  largely 
depend.  Hence  it  is  important  for  every  girl  and 
woman  to  know  something  about  how  to  manage  the  sick 
room  and  the  surroundings,  so  that  the  sick  one  will  have 
a good  chance  to  get  well  as  soon  as  possible. 

The  room  in  which  the  invalid  is  confined  to  bed  will 
have  a great  deal  to  do  with  his  comfort.  A corner 
room  with  two  windows  which  allows  a good  current  of 
air  through,  is  always  preferable,  but  in  this  as  in  other 
things  one  must  often  get  along  with  conditions  that  are 
far  from  ideal.  It  is  true,  however,  that  by  having  an 
ideal  in  mind  a much  nearer  approach  can  sometimes 
be  made  to  it  than  at  first  glance  seems  possible.  A room 
on  the  second  floor  is  more  likely  to  be  quiet.  At  the 
same  time,  if  the  home  nurse  must  preside  both  in  the 
kitchen  and  sickroom,  a room  on  the  same  floor  as  the 
kitchen  will  prove  more  convenient. 

The  furnishings  of  the  sickroom  should  be  restricted  to 
the  articles  really  necessary  for  convenience.  Useless 
draperies,  curtains,  elaborate  fancy  articles,  upholstered 
chairs  and  all  unnecessary  things  should  be  removed 
till  the  sickness  is  past.  These  catch  and  hold  the  dust 
and  add  to  the  danger  of  disease  as  well  as  to  daily  labor. 

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Any  drapery  or  piece  of  fancy  work  that  will  be  hurt  by 
washing,  any  furniture  that  will  be  injured  by  being 
wiped  with  a cloth  wet  with  a disinfectant  solution  is  out 
of  place  in  a sick  room,  especially  where  communicable 
diseases  of  any  kind  have  to  be  dealt  with. 

The  room  should  be  kept  scrupulously  clean.  Soiled 
clothing  or  slops  should  never  be  allowed  to  remain. 
Flies  should  be  kept  out  not  only  for  the  comfort  of  the 
patient,  but  because  flies  are  active  agents  in  spreading 
disease  germs. 

Flies  swarm  over  decaying  matter  outside,  and  gather 
to  themselves  disease  germs.  These  germs  are  liable 
to  be  deposited  on  food  or  dishes  later  to  be  carried  into 
the  body.  Flies  are,  because  of  their  filthy  habits  and 
ceaseless  activities,  a dangerous  kind  of  vermin  to  allow  in 
the  house  under  any  condition.  Many  thousands  of 
germs  have  been  seen  under  the  microscope  on  the 
legs  of  one  fly,  which  had  been  hovering  around  a filthy 
garbage  pail.  Food  or  drink  should  never  be  left  uncov- 
ered in  the  sickroom,  and  remains  of  food  or  drink  should 
be  promptly  removed. 

How  to  Sweep. — Do  not  sweep  rugs  in  the  sickroom 
if  it  can  possibly  be  avoided.  Take  them  outside  to  be 
brushed.  If  this  cannot  be  done,  sprinkle  the  rugs  with 
wet  tea  leaves,  or  moistened  salt,  or  tear  a newspaper  in 
small  bits,  soak  it  a few  moments  in  luke  warm  water, 
and  sprinkle  over  the  floor.  The  wet  particles  help  to 
keep  the  dust  from  floating  about.  Another  precaution 
equally  good  and  especially  useful  for  the  light  daily 
brushing  up  is,  to  tie  a damp  cloth  over  the  broom.  The 
cloth  can  be  redampened  as  the  sweeping  proceeds. 

Be  sure  that  no  food  of  any  kind  is  left  uncovered  while 
the  sweeping  is  being  done.  Do  not  sweep  just  l)efore 
meal-time.  Practise  using  short  strokes  of  the  broom, 
and  try  to  use  all  sides  and  ends  of  the  l)room,  so  that  it 
will  wear  out  evenly  and  keep  in  good  shape.  Always 
sweep  from  the  edges  to  the  center.  Gather  up  the  dust 
on  the  dust-pan  frequently  if  the  room  is  a large  one. 


THE  SICK-ROOM  AND  NURSE 


23 


Never  sweep  against  a direct  draught.  Never  sweep 
dust  from  one  room  to  another.  Burn  the  sweepings 
promptly. 

Hard-wood  floors  require  especial  care.  On  these  very 
little  water  is  used.  A brush-broom  made  of  coarse  hair 
is  best  for  such  floors.  Follow  this  by  wiping  with  a 
dry  mop. 


Fig.  3. — Nurse  sweeping  with  damp  cloth  over  broom. 


In  case  of  communicable  disease,  it  is  best  before 
sweeping  to  sprinkle  the  floor  with  some  disinfectant 
solution  such  as  bichloride  of  mercury,  and  moisten  the 
broom  in  it  before  sweeping,  and  at  intervals  during 
the  process.  In  diseases  like  diphtheria,  measles,  scarlet 
fever,  etc.,  the  broom  used  for  the  sickroom  should  not 
be  used  to  sweep  other  rooms  in  the  house. 

A broom  may  easily  spread  the  disease  germs  all  over 


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HOME  NURSE^S  HAND-BOOK 


the  house.  Pour  scalding  water  over  the  dustpan  each 
time  after  using  it  as  a precaution  in  dealing  with  such 
diseases. 

Ventilation. — Whatever  else  is  provided  the  nurse 
should  see  that  the  patient  has  plenty  of  good  clean  air 
to  breathe.  Never  forget  that  the  blood  is  purified  by 
its  contact  with  the  oxygen  in  the  lungs.  If  a fresh 
supply  of  oxygen  is  not  admitted  at  frequent  intervals 


Fig.  4. — Screen  with  blanket  and  chair. 


and  the  patient  is  forced  to  breathe  impure  air  or  air 
that  has  already  been  used,  the  health  is  necessarily 
adversely  affected.  A nurse  should  no  more  allow  a 
patient  to  breathe  impure  air  than  she  would  allow  him 
to  wash  in  or  drink  dirty  water.  No  consideration  of 
warmth  should  interfere  with  the  admission  of  pure  air. 
It  is  surely  the  poorest  of  all  methods  to  depend  on  the 
breath  of  a sick  person  to  keep  him  warm. 

An  improvised  screen  may  be  made  of  a clothes  horse 


THE  SICK-ROOM  AND  NURSE 


25 


with  a blanket  thrown  over  it;  or,  what  is  sometimes 
more  convenient,  an  umbrella  may  be  raised  that  will 
quite  effectually  shield  the  patient  from  draughts  while 
the  windows  are  opened  periodically  to  let  a good  volume 
of  air  come  in.  Another  method  is  shown  in  Fig.  4 
where  a blanket  is  secured  to  the  side  of  a window  and 
draped  over  a chair.  If  a piece  of  thin  board  about 
two  inches  in  width  can  be  procured,  it  is  a good  plan  to 
keep  one  window  raised  a couple  of  inches  all  the  time. 
This  piece  of  thin  board  fitted  across  the  opening  at  the 
bottom  of  the  sash  will  shield  the  direct  draught  from 
the  patient  and  yet  admit  a constant  supply  of  fresh  air. 

Dusting  is  removing  dust.  It  is  best  accomplished 
by  using  a damp  cloth.  A feather  duster  serves  to  stir 
up  dust  and  distribute  it,  but  does  not  remove  it.  It 
should  never  be  allowed  in  a sickroom.  In  case  of 
polished  furniture  a damp  duster  may  deface  it.  In  such 
cases,  a clean  dry  duster  should  be  used  and  frequently 
shaken  out  of  doors.  Where  the  disease  is  liable  to  be 
carried  by  floating  dust  the  duster  should  be  frequently 
wrung  out  of  a disinfectant  solution. 

Under  the  microscope  dust  resolves  itself  into  particles 
of  soot,  sand,  iron  and  steel,  glass,  lime,  woody  fiber  of 
vegetables — in  fact,  all  manner  of  vegetable  matter,  dried 
sputum,  shreds  of  linen  or  wool  from  soiled  bedding, 
pieces  of  hair,  dried  particles  of  pus,  blood  and  human 
tissue,  dried  waste  of  horses,  dogs,  cats,  and  birds,  scales 
of  skin,  fragments  of  food  of  every  sort,  with  disease 
germs  of  every  kind.  This  is  the  material  that  mingles 
itself  with  the  food;  that  is  inhaled  into  the  lungs  of  both 
sick  and  well  if  not  properly  and  frequently  removed; 
that  is  scattered  over  fruits,  vegetables,  candies,  and 
other  food  wherever  it  is  exposed  for  sale  without 
covering. 

Slops. — Never  keep  a slop  pail  in  the  sickroom.  Carry 
out  all  wash  water  and  slops  promptly;  wash  basins  and 
wipe  dry.  Scald  all  soiled  utensils  frequently. 

The  temperature  of  the  atmosphere  in  the  sickroom 


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is  a point  of  importance.  Overheated  rooms  are  bad 
for  both  sick  and  well  persons. 

For  the  average  invalid  a temperature  of  about  65°  F. 
will  be  warm  enough.  At  night  a temperature  of  55°  F. 
is  better  for  sleep,  at  which  time  an  extra  blanket  may 
be  added  if  needed.  Those  who  perspire  easily  are  apt 
to  be  easily  chilled. 

Aged  invalids,  very  young  infants,  and  those  in  which 
the  circulation  is  poor,  or  the  blood  impoverished,  will 
need  warmer  clothing  and  a warmer  room  than  those 
having  vigorous  circulation  and  plenty  of  good  red  blood. 

In  summer  it  is  difficult  to  regulate  the  temperature, 
but  the  home  nurse  should  see  that  doors  and  windows 
are  open,  and  the  air  kept  as  fresh  and  pure  as  possible, 
always  protecting  the  invalid  from  direct  draughts. 
Cold  outdoor  air  is  now  regarded  as  of  special  importance 
in  the  treatment  of  pneumonia  patients,  and  in  many  of 
the  best  hospitals,  beds  are  put  out  on  balconies  or  on 
the  roof.  In  such  cases,  besides  many  cases  of  fever  and 
other  diseases,  marked  improvement  has  resulted  from 
the  outdoor  treatment,  the  good  results  being  due  as 
much  to  the  stimulating  effect  of  the  cold  air  as  to  the 
increased  oxygen  obtained  by  the  invalid. 

Good  nursing  includes  good  general  management  of  the 
entire  situation.  It' is  not  enough  to  carry  out  the  doc- 
tor's orders  and  attend  carefully  to  the  bodily  needs  of  the 
patient,  but  in  every  home  precautions  are  needed  to 
prevent  disturbances  from  outside  sources  that  would 
mar  the  comfort  of  the  patient.  It  is  sometimes  the 
little  discomforts  that  are  the  hardest  part  of  the  situa- 
tion to  manage.  Children  persist  in  running  in  and  out 
of  the  sickroom.  In  fact,  too  often  it  forms  the  general 
meeting  ground  of  the  family.  Curious  neighl)ors  insist  on 
seeing  the  patient.  Doors  bang;  rocking  chairs  creak; 
window  shades  rattle;  the  fire  gets  low;  somebody 
l)rings  in  a distuiffiing  bit  of  news;  j)eople  insist  on 
carrying  on  a whispered  conversation  just  outside  the 
sickroom  door;  these  are  a few  illustrations  of  points 


THE  SICK-ROOM  AND  NURSE 


27 


that  require  guarding  and  prevention  in  every  illness 
of  any  importance. 

The  home  nurse  must  not  only  manage  the  patient, 
his  room,  and  the  family  and  friends  so  that  the  well 
meant  efforts  or  thoughtless  blunders  of  the  latter  do 
not  interfere  with  his  comfort  or  general  welfare,  but 
she  must  also  manage  herself.  She  should  train  herself 
always  to  knock  gently  on  the  door  before  entering  the 
sickroom.  This  is  a point  of  good  breeding  as  well  as 
good  nursing. 

Those  who  have  watched  some  trained  nurses  go  about 
their  work  have  often  envied  them  the  ability  to  make 
the  sick  one  comfortable.  They  seemed  to  know  by 
intuition  just  what  was  needed,  just  the  right  angle  at 
which  to  place  an  aching  limb,  just  the  best  way  to  fix 
the  pillows.  They  could  think  of  scores  of  things  which 
added  to  the  patient’s  comfort  and  which  the  home 
folks  would  gladly  have  done  if  they  had  only  thought 
about  it. 

The  home  nurse  must  learn  to  control  herself  first  of 
all,  her  face,  her  voice,  her  tongue,  her  emotions,  her 
nerves  and  her  temper.  If  she  really  wants  to  be  a 
comfort  to  the  patient  she  must  not  become  panic- 
stricken,  and  she  must  not  fidget. 

Fidgets  are  the  bane  of  a great  many  sickrooms.  A 
good  letting  alone  is  as  badly  needed  as  other  good 
things  in  the  sickroom,  and  should  be  planned  for  at 
regular  intervals.  Sometimes  a dozen  questions  are 
hurled  at  the  poor  patient  in  as  many  minutes.  ^^Can’t 
I do  something  for  you?”  ^^Are  you  sure  you’re  com- 
fortable?” Wouldn’t  you  like  a cup  of  tea?”  ^^Is 
your  head  high  enough?”  ^^How  is  your  pain  now?” 
Are  you  feeling  any  better?”  These  are  illustrations  of 
the  fidget’s  habits.  That  kind  of  nursing  is  simply 
teasing  the  patient.  One  of  the  first  principles  of  good 
care  of  the  sick  is  to  train  oneself  to  observe  and  antic- 
ipate what  is  needed  before  the  patient  has  to  ask  for  it, 
and  without  bothering  him  with  unnecessary  questions. 


28  HOME  nurse’s  hand-book 

A FLY  CATECHISM. 

The  following  Fly  Catechism  is  now  being  distributed  to  the 
school  children  of  North  Carolina. 

1.  Where  is  the  Fly  born?  In  manure  and  filth. 

2.  Where  does  the  Fly  live?  In  every  kind  of  filth. 

3.  Is  anything  too  filthy  for  the  Fly  to  eat?  No. 

4.  (a)  Where  does  he  go  when  he  leaves  the  vault  and  the  manure 
pile  and  the  spittoon?  Into  the  kitchen  and  dining-room. 

* (b)  What  does  he  do  there?  He  walks  on  the  bread,  fruit,  and 

vegetables;  he  wipes  his  feet  on  the  butter  and  bathes  in  the 
buttermilk. 

5.  Does  the  Fly  visit  the  patient  sick  with  consumption,  typhoid 
fever,  and  cholera  infantum?  He  does — and  may  call  on  you 
next. 

6.  Is  the  Fly  dangerous?  He  is  man’s  worst  pest,  and  more 
dangerous  than  wild  beasts  or  rattlesnakes. 

7.  What  diseases  does  the  Fly  carry?  He  carries  typhoid  fever, 
tuberculosis,  and  summer  complaint.  How?  On  his  wings 
and  hairy  feet.  What  is  his  correct  name?  Typhoid  Fly. 

8.  Did  he  ever  kill  any  one?  He  killed  more  American  soldiers 
in  the  Spanish- American  War  than  the  bullets  of  the  Spaniards. 

9.  Where  are  the  greatest  number  of  cases  of  typhoid  fever,  con- 
sumption, and  summer  complaint?  Where  there  are  the  most 
flies. 

10.  Where  are  the  most  flies?  Where  there  is  the  most  filth. 

11.  Why  should  we  kill  the  Fly?  Because  he  may  kill  us. 

12.  How  shall  we  kill  the  Fly?  (a)  Destroy  all  the  filth  about 
the  house  and  yard;  (b)  pour  lime  into  the  vault  and  on  the 
manure;  (c)  kill  the  Fly  with  a wire-screen  paddle,  or  sticky 
paper,  or  kerosene  oil. 

13.  Kill  the  Fly  in  any  way,  but  kill  the  Fly. 

14.  If  there  is  filth  anywhere  that  you  cannot  remove,  call  the 
office  of  the  Board  of  Health,  and  ask  for  relief  before  you  are 
stricken  with  disease  and,  perhaps,  death. 

Points  to  be  Remembered. — In  most  cases  of  illness 
rest  of  body  and  mind  is  an  important  part  of  the 
treatment. 

Nothing  unnecessary  in  the  sickroom  is  a good  rule. 

There  is  a right  and  wrong  way  to  sweep  and  dust. 
Study  to  manage  such  duties  properly. 

A broom  used  promiscuously  over  the  house  when 
contagious  disease  is  present  may  easily  become  an 
agent  to  spread  the  disease. 


THE  SICK-ROOM  AND  NURSE 


29 


In  nursing  there  are  no  trifles.  Nothing  is  small 
enough  to  be  careless  about. 

Be  sure  to  give  your  patient  plenty  of  clean  air  to 
breathe. 

Dusting  is  removing  dust.  Removal  is  not  accom- 
plished by  a flick  of  a feather  duster. 

Do  not  make  the  mistake  of  keeping  the  temperature 
of  the  sickroom  too  warm. 

Remember  that  fresh  cold  air  has  a stimulating  effect. 
Try  to  guard  against  the  petty  irritations  that  are 
liable  to  happen. 

Very  often  a nurse  must  take  firm  ground  to  protect 
a patient  from  his  friends.  Nothing  is  more  foolish 
than  to  allow  a weak  patient  to  waste  his  strength  or 
become  excited  or  exhausted  by  meeting  curious  visitors. 

REVIEW  QUESTIONS. 

1.  Describe  a model  sickroom. 

2.  What  care  would  you  give  a room  every  day  in  a case  of  con- 
tagious disease  ? 

3.  Mention  some  reasons  why  good  ventilation  is  important. 

4.  How  would  you  ventilate  a room  with  a patient  in  it,  if  the 
room  had  only  one  window  ? 

5.  Tell  what  you  know  about  what  dust  is  composed  of. 

6.  What  degree  of  temperature  would  you  recommend  for  a sick- 
room by  day  and  by  night. 

7.  Mention  some  precautions  you  would  take  to  guard  against 
petty  annoyances  to  the  patient. 

8.  Tell  why  flies  are  dangerous  visitors  to  allow  in  a sickroom. 

9.  How  should  a sickroom  be  swept  and  dusted. 


CHAPTER  III. 


THINGS  TO  HAVE  READY  FOR  SICKNESS. 


Demonstration  and  Practice  Work. — Making  roller  bandages- 
Explanation  of  uses  of  sickroom  utensils.  How  to  care  for  utensils 
before  and  after  using.  Improvising  screens  to  prevent  draught. 

time  of  peace  prepare  for  war is  a good  rule, 
but  in  time  of  health  prepare  for  sickness  is  an  equally 
good  rule.  Even  if  serious  illness 
does  not  come,  the  wise  home 
nurse  will  always  be  nursing 
health,  and  will  find  that  certain 
appliances  are  very  useful  in 
keeping  away  sickness,  while 
they  are  a positive  necessity  in 
serious  illness. 

A fountain  syringe  is  one  of 

the  most  useful  and  necessary 
sickroom  appliances.  These  are 
obtainable,  made  of  rubber  or 
enameled  iron,  in  gray,  blue,  or 
white,  and  also  of  tin.  The  kind 
to  be  purchased  depends  on  the 
purse  and  the  taste  of  the  buyer. 
Rubber  is  less  durable  than  the 
others  and  likely  to  spring  a leak 
when  most  needed. 

A two-quart  can  with  about 
five  feet  of  rubber  tul)ing  about 
one-quarter  inch  in  diameter 
will  prove  a satisfactory  invest- 
ment, and  will  prove  useful  in 
a variety  of  ways  in  every  home.  A set  of  three  nozzles 
should  be  secured  at  the  same  time. 

30 


Fig.  5. — P’ountain  syringe  of 
eiuunelled  iron  with  attach- 
ments. 


THINGS  TO  HAVE  READY  FOR  SICKNESS 


31 


A bed -pan  is  a vessel  used  to  catch  the  discharges  of 
urine  and  from  the  bowels  when  the  patient  is  not  able 
or  is  not  allowed  to  get  out  of  bed  to  relieve  himself. 
It  is  a necessity  in  most  cases  of  serious  illness.  The 
so-called  perfection’’  bed-pan  has  the  advantage  of 
being  easily  cleaned,  fits  the  body  better  than  the  old- 
fashioned  kind  with  a spout,  and  is  altogether  more  com- 
fortable and  sanitary.  In  emergency,  an  ordinary  wash- 


Fig.  6. — “Perfection”  enamelled  bed  and  douche  pan. 


basin  has  been  used  instead  of  a bed-pan.  A quilt 
rolled  up,  or  a stiff  cushion  is  placed  under  the  hips,  the 
edges  of  the  basin  brought  close  to  the  roll,  and  the 
patient’s  hip’s  brought  well  over  the  edge  of  the  basin. 

A rubber  sheet  is  a good  thing  to  own,  but  table  oil 
cloth  can  be  used  if  necessary.  A piece  of  oil  cloth  or  a 
rubber  sheet  about  one-half  yard  by  one  yard  is  useful  to 
slip  under  the  bed-pan  as  a protection  for  the  sheets,  to 
save  frequent  washing.  Newspapers  can  be  used  in  the 
same  way. 

A box  of  bandages  (a  shoe  box  is  large  enough)  can  be 
made  from  a well-worn  sheet  and  will  prove  useful, 
especially  in  homes  in  which  there  are  children.  The 
2-  to  2 1/ 2-inch  bandage,  and  the  1-inch  bandage  for 
fingers,  are  the  widths  most  commonly  called  for.  To 
make  the  bandages,  tear  the  cloth  the  desired  width, 
remove  selvedge  edges,  lay  the  two  ends  to  be  sewed 
together  flat  one  on  top  of  the  other  and  sew  firmly.  Re- 


32  HOME  nurse’s  hand-book 

move  the  ravelled  threads,  wind  firmly,  and  secure 
with  a pin. 

Old  linen  such  as  handkerchiefs,  table  napkins,  and 
pillow  covers  should  be  saved  for  use  in  sickness. 
Pieces  of  old  worn  blankets  and  the  backs  of  flannel 
shirts  make  excellent  material  for  applying  hot  fomen- 
tations to  the  chest  or  abdomen.  A box  of  old  linen, 
flannel,  bandages,  etc.,  in  the  attic  will  save  a general 
stampede  and  flying  hither  and  thither  hunting  for 
things  when  accident  or  illness  occurs. 


Fig.  7. — Invalid’s  “Ideal”  drinking  cup,  graduated.  An  Improved  sick 

feeder. 


A medium  size  tray  for  the  patient’s  meals  is  a necessity 
to  a refined  patient.  For  a very  small  meal,  a smaller 
tray  should  be  used  when  it  is  on  hand. 

An  individual  teapot,  sugar  bowl,  and  cream  pitcher 
should  be  counted  among  the  necessities,  not  the  luxuries 
of  a sickroom.  They  can  be  bought  for  ten  cents  each. 
Tea  or  coffee  will  taste  better  if  poured  into  the  cup,  hot 
at  the  bedside,  rather  than  downstairs  in  the  kitchen. 

Feeding  cups  are  useful  but  not  indispensable.  The 
cup  with  a spout  needs  careful  attention  to  keep  it 
sanitary. 

The  graduated  feeding  glass  with  the  number  of 


THINGS  TO  HAVE  READY  FOR  SICKNESS 


33 


ounces  or  teaspoons  marked  is  a help  to  accuracy  when 
it  is  necessary  to  know  the  exact  amount  of  fluid  taken 
by  the  patient  (Fig.  7). 

A small  cream  pitcher  is  an  excellent  thing  to  use  in 
giving  fluids  to  very  ill  patients,  when  a feeding  cup  is 
not  available. 

Improvised  Appliances. — A sheet,  shawl  or  blanket 
pinned  over  a clothes-horse  makes  a good  screen  when 
one  is  needed  to  protect  a patient  from  a draught. 


Fig.  8. — Getting  air  out  of  hot-water  bag  and  replacing  stopper. 

A roller  towel  can  be  used  in  emergency  for  an  ab- 
dominal bandage. 

Bricks  or  flat  irons  heated  and  wrapped  in  newspapers 
are  excellent  for  applying  artificial  heat  to  any  part  of 
the  body.  If  rubber  hot-water  bottles  are  used  be  sure 
to  have  the  air  out  of  the  bag  and  avoid  pins  in  cover- 
ing it. 

Where  a number  of  small  pillows  are  needed  to  make 

3 


34 


HOME  NURSE^S  HAND-BOOK 


a very  sick  patient  more  comfortable,  bags  can  be  made 
of  old  cotton  and  stuffed  with  straw  or  excelsior.  These 
are  placed  under  feather  pillows  to  give  support. 

A soap  dish  such  as  is  found  on  almost  every  wash 
stand  is  as  good  a thing  as  can  readily  be  found,  to  catch 
the  waste  water  when  washing  the  mouth  or  teeth,  or 
gargling,  when  the  patient  is  in  bed. 

The  Home  Medicine  Cupboard. — In  every  home  there 
are  minor  ailments  arising,  which  a little  common-sense 
management  will  promptly  relieve.  A great  many  of 
these  common  ailments  will  right  themselves  without 
drugs,  if  rest,  good  air,  quietness,  and  proper  dieting 
be  practised.  But  in  keeping  well,  as  also  for  use  in 
sickness,  some  drugs,  as  a rule,  are  needed. 

Olive  oil  is  one  of  the  most  useful  household  remedies. 
It  can  be  safely  used  for  a baby,  in  childhood,  and  all 
the  way  through  life  and  for  a variety  of  conditions 
externally  and  internally.  It  is  a laxative  and  a food. 
It  is  also  used  as  a soothing  application  in  case  of  super- 
ficial burns,  and  in  various  other  ways. 

Cathartics. — As  a rule  there  should  be  some  kind  of 
cathartic  medicine  kept  on  hand — some  pills  or  tablets 
that  will  stir  up  a sluggish  liver  and  bowels.  It  is  better 
to  ask  the  family  doctor  to  recommend  a good  standard 
pill  than  to  depend  on  patent  medicines.  Such  pills  can 
be  bought  in  small  bottles  containing  about  a hundred, 
at  trifling  cost. 

For  a laxative  for  children,  licorice  powder  is  easier  to 
take  than  many  other  medicines,  having  a similar  effect. 

Epsom  salts  is  a good  old-fashioned  remedy  that  never 
goes  out  of  date,  and  it  is  well  to  keep  it,  or  a l)ox  of 
seidlitz  powders,  always  on  hand,  for  use  when  prompt 
action  is  required. 

Castor  oil  is  another  medicine  that  has  stood  the  test 
of  the  years. 

Miscellaneous  Drugs. — Cdycerine  and  vaseline,  spirits 
of  turpentine  and  l)orax,  mustard  and  ginger,  are  always 
desirable  household  remedies  to  have  at  hand. 


THINGS  TO  HAVE  READY  FOR  SICKNESS 


35 


Turpentine  is  an  old  fashioned  drug  which  conies  in 
useful  for  various  conditions.  Mixed  with  olive  oil  or 
^^goosegrease^^  it  is  much  used  for  soreness  in  the 
chest,  and  it  serves  as  a liniment  for  strained  or  sore 
muscles. 

For  abrasions  of  the  skin,  chafing,  sunburn,  and  sores 
of  various  kinds,  a simple  ointment  will  be  needed.  For 
this  purpose  there  are  few  things  any  better  than  oxide 
of  zinc  ointment,  which  can  be  bought  at  any  drug  store, 
but  is  never  advertised.  An  ounce  box  will  help  to  tide 
over  many  a little  emergency. 

Vaseline  and  various  kinds  of  cold  cream  are  useful 
applications  for  these  conditions.  Boracic  acid  or  car- 
bolic acid  dissolved  in  water  are  desirable  to  have  for 
washing  cuts  or  dressing  any  ordinary  wound.  Boracic 
acid  is  safe  to  use  even  when  made  as  strong  as  possible. 

The  carbolic  acid  solution  ought  not  to  be  used  stronger 
than  a teaspoonful  of  the  acid  to  half  a pint  of  water  un- 
less ordered  stronger  by  the  physician.  It  should  always 
be  dissolved  in  boiling  water. 

It  is  well  to  remember  in  case  of  burns  with  carbolic 
acid,  that  common  vinegar  quickly  applied  will  act  as  an 
antidote  and  relieve  the  pain.  Alcohol  is  the  best  known 
antidote.  Vinegar  or  alcohol  may  be  used  either  ex- 
ternally or  internally  for  this  purpose. 

Great  care  should  be  used  to  keep  all  such  drugs  out 
of  the  way  of  children,  and  properly  labelled,  so  as  to 
avoid  accidents  and  mistakes. 

Peroxide  of  hydrogen  is  one  of  the  very  useful  house- 
hold drugs.  It  has  the  advantage  of  being  perfectly 
safe  in  unskilled  hands,  while  at  the  same  time  it  is 
powerful  in  its  cleansing  properties  and  in  its  effect  on 
disease  germs.  It  has  a wide  range  of  usefulness.  Di- 
luted about  one-half  with  clean  water  it  is  an  excellent 
wash  for  discharging  wounds. 

For  a gargle  in  sore  throat  or  tonsillitis,  for  a mouth 
wash  or  for  a foul  breath  due  to  decaying  teeth,  peroxide 
of  hydrogen  one  part,  to  three  parts  water,  is  one  of  the 


36 


HOME  NURSE^S  HAND-BOOK 


best  things  to  use  in  the  absence  of  a physician’s  order. 
If  these  drugs,  combined  with  rest,  clean  air,  quietness, 
proper  diet,  and  common  sense  are  not  sufficient  to 
tide  over  the  ailment  it  will  be  time  to  call  a physician. 
It  is  extremely  unlikely  that  some  higher  priced  drug 
with  a high  sounding  name  and  an  assuring  label,  accom- 
panied with  testimonials,  will  be  the  thing  that  is  needed. 
Instead  of  experimenting  further  in  the  dark,  call  in 
some  one  who  understands  the  human  machine,  and  let 
him  investigate  conditions  and  intelligently  prescribe. 

It  is  exceedingly  important  to  have  the  household 
remedies  kept  together  and  labelled  where  one  can  readily 
lay  hands  on  them.  In  many  of  the  modern  homes  a 
little  medicine  cabinet  is  built  in  the  bathroom,  and 
sometimes  in  some  of  the  bedrooms.  In  any  case,  a 
wall  cabinet  can  be  purchased,  or  a home  made  medicine 
cupboard  can  be  made  out  of  a medium  sized  packing 
box,  such  as  is  used  for  shipping  toilet  soap  or  cocoa. 
This  can  be  papered,  inside  and  outside;  the  cover  can 
be  put  on  with  hinges  and  fastened;  a shelf  can  be  put  in 
it,  and  the  whole  placed  high  enough  upon  the  wall,  so 
that  a child  standing  on  a chair  could  not  reach  it. 

Points  to  be  Remembered. — Every  intelligent  house- 
keeper should  keep  in  mind  the  possibilities  of  sickness 
and  keep  certain  appliances  and  remedies  where  they 
can  be  easily  found. 

A fountain  syringe  is  valuable  in  the  prevention  of 
sickness  and  a necessity  in  cases  of  serious  illness. 

Where  there  are  children,  it  is  a good  plan  to  save 
pieces  of  clean  old  linen  for  use  in  dressing  cuts  and  small 
wounds. 

Every  home  should  have  an  individual  tea  set  for 
serving  meals  in  bed. 

The  home  medicine  cupboard  or  case  of  drugs  should 
always  be  kept  out  of  the  reach  of  children. 

Never  leave  medicines  carelessly  around  on  window 
sills  or  dressers. 

See  that  every  medicine  is  labelled  and  that  bottles  of 


THINGS  TO  HAVE  READY  FOR  SICKNESS 


37 


medicine  with  one  label  on  are  not  used  to  hold  another 

drug  without  changing  the  label. 

Eternal  vigilance  is  the  price  of  safety  where  there  are 

children,  especially  where  medicine  is  concerned. 

REVIEW  QUESTIONS. 

1.  Mention  some  stock  articles  desirable  to  be  kept  in  every  home 
for  use  in  sickness. 

2.  How  would  you  make  a finger  bandage  ? 

3.  Mention  some  methods  of  protecting  the  mattress  which  you 
would  use  if  necessary. 

4.  How  would  you  improvise  a screen  from  ordinary  articles  in  a 
home? 

5.  In  stocking  up  a medicine  cupboard  for  a home  what  drugs 
would  you  include  ? 

6.  Mention  some  drugs  useful  in  dressing  wounds. 

7.  For  sunburn  or  abrasions  of  the  skin  what  simple  treatment 
would  you  use  ? 

8.  In  case  of  a burn  with  carbolic  acid  what  would  you  use  to 
relieve  it  ? 

9.  What  are  some  of  the  uses  of  peroxide  of  hydrogen  in  a home  ? 


CHAPTER  IV. 


THE  BED  AND  BEDMAKING. 

Demonstration  and  Practice  Work. — Brushing  mattress  and 
cleaning  bed  frame.  Making  empty  bed.  Making  bed  with 
patient  in  it.  Changing  sheets  with  patient  in  bed. 

The  manner  in  which  the  bed  is  cared  for  will  have  a 
great  deal  to  do  with  the  patient^s  comfort.  A well 
kept  bed  is  one  of  the  signs  that  a good  nurse  is  in  charge. 

A single  bed  is  always  preferable  to  a double  bed  for 
the  sickroom,  and  an  iron  bed  to  a wooden  one.  The 
iron  bed  does  not  absorb  or  retain  odor  or  moisture  and 
affords  no  hiding  place  for  bugs  or  other  vermin.  If  a 
bed  is  too  wide,  the  nurse  cannot  reach  the  patient  if  he 
lies  in  the  center  without  getting  on  the  bed,  a proceeding 
which  is  always  objectionable. 

The  Mattress, — The  best  mattress  is  one  of  hair  or  felt. 
Hair  is  preferable  in  a sickroom  if  there  is  room  for 
choice.  A feather  mattress  is  the  worst  possible  kind 
to  use.  It  is  soft,  sinks  into  a hole  as  soon  as  the 
patient  lies  on  it,  absorbs  moisture,  retains  odors,  and 
it  is  exceedingly  difficult  to  keep  such  a bed  smelling 
fresh  and  clean.  Further,  if  the  patient  be  entirely 
confined  to  bed  for  any  length  of  time,  it  offers  favorable 
conditions  for  the  development  of  bed  sores. 

Extra  firmness  in  a mattress  is  needed  in  many  surgical 
cases,  where  it  is  of  great  importance  to  keep  the  bed 
flat  and  level.  This  may  be  secured  by  placing  a couple 
of  thick  boards  under  the  mattress.  These  boards 
should  have  holes  bored  in  them  so  that  the  air  can 
reach  the  mattress. 

To  protect  the  mattress^  a rubber  sheet  is  desiral)le, 
especially  where  there  is  a likelihood  of  the  mattress 

38 


THE  BED  AND  BED-MAKING 


39 


becoming  wet  or  soiled  by  discharges  from  the  body, 
or  in  giving  treatments.  When  a rubber  sheet  is  not 
obtainable  a piece  of  table  oilcloth  may  be  used.  In 
either  case,  it  should  be  securely  pinned  to  the  mattress 
to  prevent  wrinkling.  In  emergency,  a thick  layer  of 
newspaper  may  be  used  underneath  the  sheet  and  bed 
pad,  as  a protection  for  the  mattress.  Over  the  rubber 
sheet,  a quilted  cotton  pad  or  thin  blanket  should  be 
used  before  putting  on  the  lower  sheet. 

Bed  Clothing. — There  is  a general  tendency  in  cases 
of  sickness  in  homes,  for  the  home  nurse  to  pile  on  too 
much  bed  clothing.  Too  much  warmth  tends  to  weaken 
the  invalid,  and  heavy  bed  clothing  is  an  unnecessary 
burden. 

Position  of  the  Bed. — It  should  be  placed  so  as  to  be 
accessible  on  three  sides,  if  possible.  When  a patient 
is  likely  to  be  confined  to  bed  for  some  time  it  is  desirable 
to  place  the  bed  so  that  he  may  look  out  of  the  window. 
Artificial  light  should  come  from  behind  the  patient 
when  this  can  be  arranged.  In  any  case,  shades  should 
be  adjusted  over  lights  so  as  to  prevent  annoyance  from 
strong  light  in  the  eyes. 

To  make  an  empty  bed  for  a sick  person  there  will  be 
needed  two  sheets,  a quilted  mattress  pad,  two  pillow 
covers,  a double  blanket  (or  single  blanket  and  light 
washable  quilt),  a bed  spread;  and  in  special  cases,  a 
rubber  sheet  to  protect  the  mattress  and  a draw  sheet 
to  cover  it.  Have  these  ready  and  arranged  on  a chair 
in  the  order  in  which  they  will  be  placed  on  the  bed. 
First  be  sure  that  the  mattress  has  been  brushed  and 
the  springs  and  the  bed  frame  cleaned.  One  who  under- 
stands bed  making  thoroughly  will  be  able  to  make  an 
empty  bed  by  going  around  it  once. 

The  mattress  pad  is  first  placed  in  position.  The 
lower  sheet  is  unfolded,  the  wide  hem  placed  at  the  head 
of  the  bed  and  the  middle  fold  placed  exactly  in  the 
middle  of  the  bed.  Allow  enough  to  come  well  over  the 
upper  end  of  the  mattress.  Tuck  it  under  firmly  as  far 


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as  can  be  reached  from  across  the  bed.  The  corner  is 
finished  squarely,  and  the  edge  of  the  sheet  tucked  singly 
along  the  side,  underneath  the  mattress  and  the  foot. 

The  rubber  sheet  is  next  put  on.  It  should  be  large 
enough  to  reach  the  edge  of  the  pillows  at  the  top,  to 
come  down  well  under  the  hips,  and  to  tuck  snugly 
underneath  the  mattress  at  each  side. 

The  draio  sheet  is  a smaller  sheet  placed  over  the 
rubber  sheet.  Its  use  saves  changing  the  lower  large 


Fig.  9. — Bed  finished,  turned  down  ready  for  convalescent  patient. 

sheet  as  often  as  would  otherwise  be  necessary.  It 
can  be  drawn  from  under  a patient  and  replaced  by  a 
clean  one  with  very  little  disturbance  or  exertion.  The 
ru]j])er  sheet  with  the  draw  sheet  over  it  must  be  drawn 
firmly  and  tightly  over  the  mattress  and  secured  by 
safety  pins  undei'neath  at  each  corner.  The  rul)ber 
sheet  is  only  necessary  for  the  protection  of  the  bed  and 
should  be  removed  when  not  needed. 

To  put  on  the  upper  sheets  place  the  wide  hem  at  the 


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41 


top,  the  middle  of  the  sheet  in  the  center  of  the  bed  and 
tuck  in  first  at  the  bottom  firmly  at  least  five  inches. 
It  should  then  be  drawn  up  smoothly  and  tightly  toward 
the  top. 

The  double  blanket  is  put  on  next  with  the  fold  at 
the  bottom.  The  spread  and  the  blanket  should  be 
tucked  in  snugly  at  the  foot  so  that  their  edges  will 
reach  easily  to  the  patient’s  neck.  Avoid  too  much 
clothing  at  the.  upper  end.  The  blanket  is  tucked  in 


Fig  10. — Changing  a draw  sheet. 


snugly  at  the  sides  underneath  the  mattress.  The  spread 
is  left  free  and  its  corners  turned  neatly  and  squarely. 

To  finish  the  opposite  side  the  nurse  goes  to  the  other 
side  of  the  bed,  turns  the  upper  covers  back,  tucks  in 
the  lower  sheet  tightly  with  square  corners,  secures  the 
rubber  sheet  and  draw  sheet  with  safety  pins,  arranges 
the  upper  sheet  as  on  the  other  side,  and  the  blankets 
likewise.  The  spread  or  counterpane  is  then  drawn  up, 
and  the  end  of  the  upper  sheet  folded  back  over  it  neatly. 


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The  pillows  are  then  shaken  and  the  covers  smoothed 
neatly  and  placed,  one  flat  with  the  open  end  of  the 
pillow  cover  always  away  from  the  door,  and  the  other 
arranged  upright  on  it,  leaning  against  the  head  of  the 
bed.  The  bed  is  then  ready  to  be  turned  down  for  the 
patient.  If  a spread  is  not  desirable  or  available,  cover 
the  blankets  with  another  sheet  to  give  the  bed  a finished 
look. 


Fig.  11. — Changing  a sheet. 


To  change  the  bed  with  the  patient  in  it  without 
needlessly  jarring  or  causing  exertion  to  the  sick  one  is 
an  art  that  requires  practice  to  do  it  easily.  Have 
everything  at  hand  before  beginning,  llemove  the 
safety  pins  from  the  draw  sheet,  take  off  the  spread, 
arranging  it  neatly  so  as  not  to  touch  the  floor.  Take 
away  one  pillow.  Loosen  all  the  clothing  at  the  sides. 

Changing  the  lower  sheet  is  not  difficult  if  the  directions 
are  closely  followed.  Assist  the  patient  to  the  edge  of 
the  l)ed  opposite  to  the  one  on  which  it  is  proposed  to 
begin  changing.  In  turning  the  patient,  be  sure  to 


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43 


support  the  parts  of  the  body  which  need  it  most.  If  a leg 
is  fractured,  lift  it  carefully  and  hold  it  while  the  patient 
rolls  over.  If  the  patient  has  typhoid  fever  or  an  ab- 
dominal wound  the  nurse^s  hands  should  be  slipped 
under  the  hip  and  side.  If  the  patient  is  to  be  brought 
to  the  left  side  go  to  the  left  side  of  the  bed,  stoop,  and 
slip  the  right  hand  under  the  patient^s  right  shoulder, 


Fig.  12. — How  to  lift  an  injured  or  painful  leg. 


and  the  left  hand  under  the  right  hip.  Then  slowly 
turn  her  toward  you,  always  being  careful  that  the 
support  is  given  with  the  whole  hand,  not  with  the 
fingers  alone,  and  that  the  finger  nails  do  not  press  into 
the  skin. 

When  the  patient  has  thus  been  brought  to  the  edge 
of  the  left  side  of  the  bed,  the  nurse  goes  to  the  opposite 
side,  rolls  up  the  lower  sheet,  the  draw  sheet,  and  the 


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rubber  sheet  against  the  patient^s  back.  The  clean 
lower  sheet  is  then  put  on  the  right  half  of  the  bed  as 
directed  in  making  the  empty  bed,  and  the  rubber  sheet 
drawn  down  by  tucking  one  edge  under  the  mattress  and 
securing  it  with  safety  pins.  The  patient  is  then  brought 
gently  over  to  the  side  freshly  made,  the  soiled  lower 
sheet  and  draw  sheet  are  removed,  the  clean  ones  drawn 
tightly  over  and  properly  secured  under  the  mattress, 
keeping  the  corners  square.  Avoid  tugging  or  pulling  a 
sheet  forcibly  from  under  any  sick  person. 

To  change  the  upper  sheets  the  home  nurse  must 
practice  to  do  it  quickly  and  neatly  and  avoid  exposure. 
The  clothes  are  first  freed  from  the  foot  and  sides,  and 
the  blankets  turned  back,  leaving  only  the  soiled  upper 
sheet  over  the  patient.  Before  removing  this  spread  the 
clean  one  over  it,  and  tuck  it  in  firmly  at  the  bottom. 
Let  the  patient  hold  the  upper  end  of  the  clean  sheet, 
while  the  hands  are  slipped  underneath  it  and  the  soiled 
one  drawn  out.  The  blankets  are  then  spread  and 
drawn  smoothly  up,  and  the  extra  length  of  the  upper 
sheet  turned  back  over  them. 

A well  made  bed  will  have  the  clothes  on  straight  and 
tight.  It  will  be  smooth  and  free  from  wrinkles.  After 
the  bed  is  finished  run  the  hand  from  foot  to  top  of  bed, 
and  test  the  result  for  smoothness,  tightness,  and  free- 
dom from  wrinkles. 

A badly  made  bed  has  the  appearance  of  being  thrown 
together  loosely,  carelessly  and  without  method. 

To  change  the  pillowcovers  stand  at  the  right  side  of  the 
patient  if  the  bed  is  arranged  so  that  this  is  possible. 
Then  gently  slip  the  left  hand  under  the  upper  pillow  (if 
there  are  two)  and  let  the  patient^s  head  rest  on  your  arm. 
With  the  right  hand  over  the  patient  draw  out  the  pillow 
on  the  opposite  side  and  let  the  j^atient’s  head  gently 
down.  Shake  the  pillow  thoroughly  after  removing 
the  cover.  Put  on  the  clean  cover,  smoothing  out  and 
folding  neatly  under  it  any  surplus  covering.  Then 
slip  the  hand  under  the  patient’s  head  and  support  it 


THE  BED  AND  BED-MAKING 


45 


while  drawing  out  the  pillow  left  to  the  opposite  side, 
and  replacing  it  with  the  clean  fresh  one.  Never  let  a 
patient’s  head  drop  with  a jerk. 

Avoid  Exposure. — In  making  a bed  or  changing  a 
gown  or  giving  a bath  or  treatment  of  any  kind  the  home 
nurse  should  always  remember  this  injunction.  It  is 
never  necessary  to  completely  uncover  a patient.  The 
refined  well-bred  nurse  will  always  manage  the  work  so  as 
to  avoid  needless  exposure. 


Fig.  13. — Changing  pillow. 


In  cold  weather  the  room  should  be  comfortably  warm, 
and  at  all  times  clothing  should  be  carefully  aired. 
Dampness  in  a bed  or  bedding  is  always  to  be  avoided. 

To  make  a bed  with  a patient  in  it  without  changing 
the  sheets,  free  the  bed  clothing  at  the  top,  bottom,  and 
sides.  Brush  out  carefully  all  crumbs,  lint,  etc.  A 
whisk  broom  is  a good  thing  for  this  purpose,  or  a half 
soiled  towel.  Do  not  brush  the  bed  with  a towel  you 
expect  to  use  for  the  patient’s  face  or  hands.  Straighten 
the  clothing,  see  that  all  wrinkles  in  the  lower  sheet 


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or  gown  are  smoothed  out.  Draw  each  piece  of  covering 
separately  and  tuck  in  tightly  as  previously  directed. 
Shake  the  pillows,  turn,  and  replace. 

This  should  be  done  at  least  morning  and  evening 
with  every  patient  who  is  obliged  to  be  in  bed  the  whole 
day. 

Points  to  be  Remembered. — A well  kept  bed  is  one  of 
the  signs  of  a good  nurse. 

Iron  beds  are  more  sanitary  than  wooden  ones  and 
a hair  mattress  is  preferable  for  the  sickroom. 

Too  much  bed  clothing  weakens  a patient. 

Be  sure  to  have  a method  in  your  bed  making.  Criti- 
cise your  efforts  and  see  where  you  might  have  improved. 

In  changing  a bed  for  man  or  woman  always  be 
careful  to  avoid  exposure. 

A well  made  bed  will  have  the  clothing  on  tight,, 
straight  and  free  from  wrinkles. 

When  a patient  is  constantly  in  bed,  the  condition  of 
the  bed  requires  periodical  attention.  Making  it  once  a 
day  is  not  sufficient. 

REVIEW  QUESTIONS. 

1.  Give  reasons  why  an  iron  bed  is  preferable  to  a wooden  bed. 

2.  Tell  why  a feather  bed  should  not  be  used  in  sickness. 

3.  How  would  you  make  an  empty  bed  for  a sick  person  to  occupy  ? 

4.  Describe  the  method  of  changing  a bed  with  the  patient  in  it. 

5.  Mention  some  of  the  chief  characteristics  of  a well  made  bed. 

6.  How  would  you  make  a bed  with  a patient  in  it  without  chang- 
ing the  sheets? 


CHAPTER  V. 


THE  PERSONAL  CARE  OF  THE  INVALID. 

Demonstration  and  Practice  Work. — A cleansing  sponge  bath  in 
bed.  Changing  the  gown  of  a helpless  patient.  Cleansing  the 
mouth  of  a seriously  ill  fever  patient. 

First  Things  to  be  Done. — Whatever  the  threatened 
or  the  actual  disease  or  disorder  may  be,  there  are  two 
things  to  be  done  at  the  very  beginning — to  secure  rest 
for  the  part  affected  (and  preferably  rest  and  quietness 
for  the  whole  body)  and  to  keep  the  patient  with  a clean 
skin  and  clean  clothing,  on  a clean  bed  in  a clean  room 
with  clean  air  to  breathe.  This  means  simply  keeping 
him  in  the  most  favorable  condition  for  nature  to  begin 
the  restorative  process.  It  is  as  a rule  far  more  essential 
to  attend  to  these  simple  duties  than  to  rush  to  the 
corner  drug  store  for  something  to  cure  the  ill.  Atten- 
tion to  these  points  will  often  ward  off  serious  trouble 
and  in  many  cases  is  all  that  is  necessary  to  bring  about 
a cure.  These  suggestions  are  important  to  be  observed 
in  every  disease,  more  important  in  most  cases  than  the 
most  faithful  dosing  with  medicines. 

Rest  also  includes  freedom  from  petty  worries,  from 
necessity  for  continued  thinking,  from  interruptions, 
from  unnecessary  or  unexpected  jolts  or  any  kind  of  jars, 
from  the  creaking  of  chairs  or  doors,  rattling  of  windows, 
from  squeaky  shoes  or  rustling  skirts.  The  bad  practice 
of  sitting  on  the  bed  should  be  guarded  against. 

In  giving  drinks  or  liquid  nourishment  to  a bed 
patient  always  slip  the  left  hand  underneath  the 
pillow  rather  than  directly  under  the  head  of  the  patient 
when  offering  the  drink. 


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The  Daily  Routine. — In  every  home  in  which  there  is 
a patient  confined  to  bed  there  is  a certain  routine  of 
duties  which  need  to  be  done  every  day,  if  the  patient  is 
to  be  kept  comfortable,  and  in  a condition  favorable  for 
recovery.  If  the  invalid  wakes  early  in  the  morning, 
a hot  nourishing  drink  of  some  kind  such  as  gruel,  coffee 
with  plenty  of  milk,  cocoa,  beef  tea,  etc.,  may  in  many 
cases  wisely  be  given.  This  helps  to  tide  over  and  gives 


Fig.  14. — Lifting  patient’s  shoulder. 


a chance  to  devote  a little  more  attention  to  the  regular 
breakfast  an  hour  or  two  later.  If  he  has  fever,  the 
morning  temperature  should  be  taken  as  soon  after  he 
awakes  as  possible,  and  this  should  be  written  down  and 
kept  for  comparison  from  day  to  day.  Directions  about 
temperature  will  he  given  in  later  lessons. 

Tlie  face  and  hands  are  bathed,  the  mouth  washed, 
and  the  patient  placed  in  a comfortable  position  for 
breakfast.  After  breakfast  he  may  be  allowed  to  rest 


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49 


awhile.  Then  will  follow  either  a cleansing  bath  with 
soap  and  water,  or  an  alcohol  rub,  the  combing  of  the  hair, 
brushing  out  the  crumbs,  and  the  making  of  the  bed. 
Next  the  room  is  tidied  and  dusted  with  a damp  cloth. 
Medicines  and  treatments  are  attended  to  as  ordered. 
When  this  is  done,  the  room  should  be  given  a thorough 
airing.  If  the  weather  is  cold,  throw  an  extra  blanket 
or  quilt  over  the  patient,  tucking  it  in  close  about  the 
neck;  see  that  he  is  screened  from  direct  draughts,  open 


Fig.  15. — Lifting  patient  in  bed. 


the  windows  and  doors  wide  and  fill  the  room  with  good 
air.  Be  sure  to  do  this  at  bedtime  also. 

Quite  often  by  the  time  these  duties  have  been  at- 
tended to  the  patient  is  ready,  to  doze  or  rest  again 
for  an  hour  or  two.  To  see  that  he  is  allowed  to  rest  un- 
disturbed by  petty  questions  or  annoyances  of  any 
kind  is  as  important  as  any  part  of  the  treatment. 
Many  invalids  have  a tendency  to  slip  down  toward  the 
foot  of  the  bed.  If  very  weak  or  ill  they  must  be 

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gently  lifted  toward  the  head  of  the  bed  once  or  twice 
every  day. 

Most  patients  like  to  have  their  hands  wiped  off  with 
a damp  cloth  or  washed  before  each  meal,  and  the  home 
nurse  should  at  least  offer  to  do  it. 

Medicines  that  are  ordered  to  be  given  before  meals 
should  be  given  a half  hour  before,  in  the  absence  of 


more  definite  orders,  and  the  same  length  of  time  should 
be  allowed  to  elapse  before  giving  after-meal  doses. 

Getting  Ready  for  the  Night. — Every  patient  should, 
when  possible,  be  settled  for  the  night  by  nine  o'clock. 
Preparations  for  the  night  may  wisely  begin  at  least  a 
half  hour  earlier.  Everything  likely  to  be  needed  during 
the  night  should  be  in  readiness;  bedtime  nourishment 
or  treatment  attended  to;  the  patient's  face,  hands,  and 
feet  bathed;  the  back  rubbed  with  dilute  alcohol;  the 


Fig.  16.— Pushing  patient  up  in  bed,  two  nurses  present. 


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51 


bed  straightened  and  brushed  free  from  crumbs;  the 
pillows  shaken.  Always  see  that  the  patient^s  feet  are 
warm  before  leaving  him  for  the  night. 

When  the  windows  have  been  opened  and  the  room 
filled  with  clean  air  the  patient  is  then  ready  for  sleep. 
These  are  the  routine  duties  that  require  to  be  done  for 
every  patient  who  is  confined  to  bed. 

Opportunities  for  numerous  other  little  attentions  that 
will  add  much  to  a patient's  comfort  will  come  every 
day. 


Fig.  17. — Bathing  leg.  Note  arrangement  of  blankets  to  avoid  exposure. 


Baths  are  given  to  the  sick  for  a variety  of  purposes. 

1.  For  cleanliness.  2.  To  promote  comfort.  3.  To 
induce  perspiration.  4.  To  soothe  and  quiet.  5.  To 
cool  the  body  when  there  is  fever,  etc. 

Many  of  the  sick  have  a dread  of  catching  cold,  and 
regard  baths  as  dangerous. 

Cleanliness  is  always  a help  to  getting  well.  It  always 
promotes  comfort,  and  the  patients  are  very  few  and 


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far  between  who  cannot  be  bathed  without  danger  if 
the  home  nurse  is  careful  to  observe  proper  percautions. 

The  Cleansing  Sponge  Bath. — In  unskilled  hands  it  is 
wise  to  guard  against  accidents  by  protecting  the  bed 
with  an  old  or  thin  blanket.  A very  large  bath  towel 
is  often  used.  It  is  laid  under  each  part  that  is  being 
bathed.  The  room  should  be  warm  and  free  from 
draughts.  Everything  likely  to  be  needed  should  be 
ready  before  starting  the  bath — hot  and  cold  water,  soap, 
washcloth,  towels,  clean  clothing.  Turn  back  the  spread. 
Always  keep  the  patient  covered  either  with  sheet  or 
blanket.  The  face,  ears,  and  neck  should  be  bathed 
first,  and  carefully  dried,  then  one  arm  at  a time,  keeping 
all  but  the  part  that  is  being  bathed  under  cover.  Then 
the  chest  and  abdomen,  then  one  limb  at  a time  and  lastly 
the  back.  An  alcohol  rub  over  the  whole  body,  following 
the  bath  is  usually  much  appreciated  by  the  sick.  The 
alcohol  should  be  diluted,  about  two  parts  of  water  to 
one  of  alcohol  being  used,  as  pure  alcohol  has  the  effect 
of  drying  the  skin. 

The  finger  nails  should  be  scraped  underneath  and 
clipped  short  so  as  to  afford  scant  hiding  place  for  dirt 
or  germs. 

Changing  the  Gown. — If  a patient  is  very  ill,  it  is 
always  best  to  rip  or  cut  the  gown  all  the  way  down  the 
front.  The  patient's  strength  and  comfort  are  much 
more  important  than  any  gown.  If  a shirt  is  worn  under 
the  gown,  fit  one  garment  inside  the  other  before  putting 
it  on.  To  change  a gown  that  is  not  open  all  the  way 
down,  slip  off  the  sleeves  of  the  soiled  one  and  pull  it  up 
toward  the  neck.  Put  the  arms  in  the  leeves  of  the 
clean  gown,  support  the  head  and  shoulders,  slip  the 
soiled  gown  off,  draw  the  clean  one  over  the  head  and 
pull  it  down  smoothly.  If  an  arm  or  shoulder  is  injured 
slip  the  sleeve  off  the  arm  on  the  opposite  side  first. 

Washing  the  Mouth. — When  the  cleansing  bath  is 
completed  it  is  time  to  wash  the  patient's  mouth. 

This  should  never  be  neglected.  In  the  nursing  of 


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53 


some  fevers  it  is  an  important  part  of  the  treatment. 
The  washing  of  the  mouth  and  teeth  may  be  done  with 
plain  lukewarm  water,  or  some  form  of  mouth  wash  may 
be  used.  The  following  substances  are  sometimes  used 
as  mouth  washes: 

A half  teaspoon  of  baking  soda  in  a tumbler  of  water. 
_ or, 

Equal  parts  of  lemon  juice  and  glycerine,  using  about 
a teaspoon  of  the  mixture  to  a glass  of  cold  water. 

A little  borax  is  often  added. 

or. 

One  part  peroxide  of  hydrogen  to  three  parts  of  water. 

Sometimes  the  doctor  orders  a special  drug  of  some 
kind  to  be  put  in  the  water  used  for  washing  the  mouth. 
If  the  patient  is  not  able  to  brush  his  teeth,  some  little 
bits  of  clean  cotton  or  soft  old  linen  around  the  index 
finger  may  be  used. 

Try  to  clean  between  the  teeth.  This  is  most  easily 
done  by  twisting  a bit  of  absorbent  cotton  around  the 
point  of  a tooth  pick,  dipping  it  in  the  mouth  wash  and 
rubbing.  Care  should  be  used  not  to  break  the  mucous 
membrane  which  lines  the  mouth.  If  the  lips  are  dry, 
apply  a little  cold  cream  or  vaseline  to  prevent  cracking. 

In  caring  for  the  mouth  in  typhoid  fever  the  home 
nurse  should  always  remember  that  the  germs  of  the 
disease  are  in  the  mouth  in  great  numbers,  and  neglect 
to  carefully  cleanse  her  own  hands  after  washing  the 
patient’s  mouth  may  lead  to  the  nurse  herself  contracting 
the  disease.  Burn  the  bits  of  cotton  used  for  cleansing 
the  mouth  of  any  patient. 

Combing  the  Hair. — Unless  the  doctor  has  positively 
said  the  hair  must  not  be  combed,  this  duty  should  be 
attended  to  at  least  once  every  day  for  every  sick  person, 
and  especially  for  women  and  children  who  have  long 
hair.  If  the  patient  is  to  be  in  bed  constantly,  and  the 
hair  is  long,  it  is  better  to  part  it  in  two  braids.  If  the 
ends  are  properly  secured  this  will  prevent  it  getting 
tangled. 


54 


HOME  nurse’s  hand-book 


Begin  to  comb  at  the  end,  holding  the  braid  tightly 
in  the  left  hand  and  the  comb  in  the  right  hand.  Do 
not  attempt  to  comb  the  hair  on  the  top  of  the  head 
till  the  ends  are  straightened.  Then  hold  the  patient’s 
head  firmly  with  the  left  hand  while  finishing  the  comb- 
ing. A good  careful  home  nurse  will  not  allow  a sick 
one  to  have  tangled  hair.  Very  often  it  will  soothe  a 
patient  who  is  nervous  and  restless  to  spend  fifteen  or 
twenty  minutes  in  brushing  and  combing  the  hair. 
Bathe  the  face  and  hands  after  it  is  through,  and  shake 
and  turn  the  pillows.  Straighten  out  wrinkles  in  sheets 
or  gown  before  leaving  the  patient. 

If  the  hair  is  badly  tangled  and  the  patient  is  weak, 
do  not  try  to  comb  it  all  at  one  attempt.  It  may  take 
several  days,  doing  a little  at  a time,  so  as  not  to  exhaust 
the  sick  one’s  strength,  or  unduly  worry  him. 

Vermin  in  the  hair  requires  special  attention.  There 
are  various  preparations  used  to  kill  vermin  in  the  hair. 
In  most  cases  it  will  be  best  to  try  a fine  comb,  and  then 
thoroughly  wash  the  hair.  When  it  is  nearly  dry,  a 
preparation  called  larkspur  may  be  applied  and  the 
head  tied  up  in  a towel.  If  larkspur  is  not  to  be  had, 
coal-oil  may  be  used. 

To  destroy  nits  apply  hot  vinegar  to  the  hair  and 
then  follow  in  a few  hours  with  a fine  tooth  comb. 

Points  to  be  Remembered. — Favorable  conditions  for 
recovery  from  sickness  require  a clean  bed^  clean  clothing 
and  room,  clean  air  to  breathe,  suitable  food  and  rest. 

Cultivate  a quiet,  restful  demeanor  in  dealing  with 
the  sick  and  do  not  constantly  discuss  their  condition 
with  them. 

Most  patients  will  appreciate  a hot  drink  in  the  early 
morning  hours,  the  regular  breakfast  to  come  later. 

A bath  properly  given  has  rarely  if  ever  hurt  any 
patient  and  cleanliness  is  a distinct  aid  to  comfort  and 
recovery. 

Rememl)er  that  the  patient’s  mouth  needs  to  l^e 
washed  more  frequently  in  sickness  than  in  health. 


THE  PERSONAL  CARE  OF  THE  INVALID 


55 


Have  everything  ready  to  give  a bath  before  beginning 
it.  Never  leave  a patient  uncovered  while  giving  a bath. 
Uncover  one  part  at  a time. 

Do  not  neglect  to  comb  hair,  especially  long  hair, 
every  day. 

REVIEW  QUESTIONS. 

1.  Mention  some  of  the  first  things  to  be  done  for  a patient  when 
illness  is  present  or  threatened. 

2.  What  general  care  would  you  give  a bed  patient  every  day? 

3.  Mention  some  precautions  you  would  take  in  regard  to  giving 
of  medicines  in  relation  to  food. 

4.  Describe  your  method  of  giving  a cleansing  sponge  bath  in  bed. 

5.  Give  five  purposes  for  which  baths  are  given. 

6.  How  should  changing  the  gown  be  accomplished  in  cases  of 
serious  illness? 

7.  Mention  some  substances  which  might  be  used  as  mouth 
washes  for  the  sick. 

8.  What  special  precautions  would  you  take  in  cleansing  the 
mouth  of  a typhoid  fever  patient  and  why? 

9.  What  general  rules  would  you  follow  in  combing  tangled  long 
hair? 

10.  Mention  some  substances  which  are  used  to  kill  vermin  in  the 
hair. 


CHAPTER  VI. 


THE  PERSONAL  CARE  OF  THE  INVALID  (continued.) 

Demonstration  and  Practice  Work. — Adjustment  of  pillows. 
Propping  a patient  up  in  bed.  Methods  of  relieving  pressure  when 
a bed  sore  is  threatened.  Making  a home-made  circular  cushion 
with  cotton  batting  and  a bandage. 

To  keep  the  patient  as  comfortable  as  possible  is 
one  of  the  home  nurse’s  first  duties.  It  is  fully  as  im- 
portant as  giving  him  medicine  regularly,  and  includes 
a great  variety  of  attentions,  not  all  of  which  can  be 
mentioned.  Humor  the  patient  always  when  it  makes 
no  difference.  There  may  be  occasions  when  gentle 
discipline  of  the  patient  is  necessary,  but  as  a rule  the 
time  of  sickness  is  not  the  time  to  work  reforms  in  the 
patient’s  habits.  There  are  some  patients,  it  is  true, 
who  demand  attention  out  of  all  proportion  to  their 
real  needs,  and  who  have  no  consideration  for  the  nurse 
or  any  one  else.  A measure  of  discipline  is  necessary 
in  such  cases,  but  even  in  these  their  fads  and  fancies 
should  not  be  lost  sight  of.  Pleasing  the  patient  is 
always  and  everywhere  an  important  item  in  nursing. 
But  on  the  other  hand  a nurse’s  ^^No”  should  mean 
^^No,”  and  the  patient  must  learn  that  no  amount  of 
pleading  or  fretting  will  procure  for  him  something  that 
will  do  him  harm.  He  is  to  be  humored  only  when  it 
makes  no  difference.  For  his  own  good,  unless  a patient 
is  very  ill,  delirious,  or  unconscious,  he  needs  to  be  left 
entirely  alone  at  intervals  during  the  day,  for  complete 
rest. 

Cold  feet  are  common  in  many  diseases.  The  nurse 
should  not  wait  to  be  told  about  them,  but  should  slip 
her  hands  under  the  bed  clothing  occasionally  and  find 

56 


THE  PERSONAL  CARE  OF  THE  INVALID 


57 


out  if  the  feet  are  comfortably  warm.  Artificial  heat 
may  be  applied  by  using  a rubber  bag  filled  with  warm 
water,  or  by  using  hot  bricks  or  irons  always  wrapped 
in  a cloth  or  thick  papers  before  they  are  put  in  the  bed. 
In  case  of  hot  water  bags  use  no  pins  in  the  cloth  cover- 
ing as  punctures  easily  occur.  Never  leave  hot  water 
bottles  or  heating  devices  in  contact  with  a delirious  or 
unconscious  person. 

Delirious  patients  should  never  be  left  alone.  In  re- 
straining a struggling  patient  be  sure  not  to  let  your 
weight  rest  on  the  chest  or  abdomen. 


Fig.  18. — How  to  hold  a struggling  patient.  Nurse’s  weight  resting  on  patient’s 

thighs. 

General  Suggestions. — Turning  the  pillows  and  shaking 
them,  rubbing  the  back  and  limbs  gently,  keeping  the 
shades  adjusted  so  as  to  prevent  annoyance  from  light, 
putting  a pillow  beneath  the  knees,  or  at  the  back,  are 
little  attentions  that  promote  comfort.  If  the  patient 
is  hot  and  restless,  it  refreshes  him  to  bathe  the  face  and 
hands,  to  straighten  out  the  sheets  and  shake  them 
gently  before  tucking  them  in  again. 


58 


HOME  nurse's  hand-book 


Small  pillows  can  be  used  to  fit  into  the  hollow  of  the 
back  or  under  a shoulder  or  to  give  support  to  any  part. 
Be  careful  to  adjust  the  pillows  under  the  head  so  as  to 
be  most  comfortable  to  the  patient. 

Talking  too  much,  even  when  one  is  well,  is  a serious 
drain  on  the  strength.  Many  patients,  especially  those 
of  a nervous  type,  are  inclined  to  waste  strength  they 
cannot  afford  to  lose  in  needless  talking.  A wise  tactful 
home  nurse  will  try  to  restrain  this  tendency  in  patients 
of  weakened  vitality. 

The  bladder  needs  to  be  kept  in  mind  in  practically 
all  cases  of  illness.  Watch  the  bladder'’  is  an  im- 
portant precaution.  Over-distention  of  the  bladder  may 
occur  even  when  the  patient  is  able  to  pass  urine  nat- 
urally. Very  often,  especially  in  aged  patients,  the 
bladder  does  not  fully  empty  itself  when  urine  is  passed. 
A patient  may  be  too  ill  to  complain  even  when  the 
bladder  is  over  full. 

Difficult  breathing  is  of  frequent  occurrence.  Patients 
who  suffer  in  this  way  usually  have  to  be  propped  up. 
Sometimes  such  patients  like  to  lean  forward  or  rest  the 
head  on  one  side.  If  the  sickness  is  likely  to  be  pro- 
longed, it  will  add  to  the  comfort  to  provide  a wide 
board  about  two  feet  long  for  the  back  with  a narrow 
piece  attached  to  each  side,  for  a back  and  head  rest. 
This  can  be  supported  by  an  inverted  chair  and  well 
padded  with  pillows. 

To  prop  a patient  up  in  bed  and  keep  him  comfortable 
in  a sitting  position,  several  points  need  to  be  observed. 
At  least  five  pillows  will  be  needed  if  there  is  no  back 
rest.  Two  or  three  pillows  will  do  if  the  patient  is 
supported  by  an  inverted  chair  or  back  rest,  l^e  sure 
to  see  that  the  pillows  come  well  down  to  the  base  of  the 
spine,  that  the  support  is  even,  that  tlie  head  is  not 
thrown  forward  on  the  chest,  nor  allowed  to  tilt  too  far 
backward.  A board  with  the  ends  placed  on  a box  or  a 
pile  of  magazines  on  each  side  of  the  bed  makes  a 
table  for  use  in  this  position  which  is  often  a comfort 


THE  PERSONAL  CARE  OF  THE  INVALID 


59 


for  him  to  lean  on.  A bed  tray  with  a pillow  on  it  can 
be  used. 

In  patients  in  which  there  is  a discharge,  see  that  the 
surrounding  parts  do  not  become  excoriated.  Proper 
attention  to  cleanliness  will  usually  prevent  this. 

In  lifting  patients  always  support  the  parts  of  the 
body  which  are  in  special  need  of  support.  Practice 
gentleness  in  all  that  you  do.  Never  sit  on  a bed. 


Fig.  19. — ^Patient  with  pillow  in  uncomfortable  position. 


Snipping  the  edge  of  a roller  bandage  on  an  extremity, 
when  it  seems  to  cause  pain,  thus  easing  the  pressure  on 
the  wounded  part,  arranging  it  at  just  the  right  angle  for 
comfort,  adjusting  the  pillows  till  the  shoulders  and  head 
are  comfortably  supported;  shading  the  glare  of  artificial 
light  from  the  eyes;  moistening  parched  lips;  elevating 
a part  gradually  and  supporting  evenly,  so  that  no  part 
is  strained;  these  are  all  measures  to  be  used  as  oppor- 
tunity occurs,  and  all  are  helps  to  comfort.  Adapt  your 
comfort’^  methods  to  the  needs  of  the  individual 
patient. 


60  HOME  nurse’s  hand-book 

To  get  a patient  up  in  a chair,  first  put  on  stockings 
and  slippers,  if  these  are  to  be  had.  In  cold  weather  put 
on  drawers.  A wrapper  or  bath  robe  over  the  night 
gown  is  sufficient  to  wear  for  the  first  attempt  to  sit  up 
after  being  sick.  Have  beside  the  bed  a comfortable 
chair,  with  arms  and  a back  high  enough  to  support  the 
head.  Place  one  pillow  in  the  seat  and  another  in  the 
back,  and  throw  a blanket  over  these.  Lift  or  help  the 
patient  into  the  chair,  wrap  the  blanket  around  him 
snugly,  pin  around  the  feet,  with  a safety  pin  and  rest  the 
feet  on  a stool.  After  a serious  illness,  from  fifteen  to 
thirty  minutes  are  usually  as  long  as  he  should  be  allowed 
to  sit  up  the  first  time. 

Bed  -sores  are  sores  which  result  from  continuous 
pressure  on  certain  spots,  from  friction  between  two 
surfaces,  from  moisture,  wrinkles  or  creases  in  the  under 
sheet,  or  lack  of  cleanliness.  They  are  more  likely  to 
occur  in  helpless  patients  such  as  paralytic,  or  in  old,  or 
very  heavy,  or  very  emaciated  subjects,  or  in  surgical 
cases,  which  require  the  patient  to  be  kept  in  one  position 
a great  deal.  They  may  occur  in  any  case  if  a nurse  is 
not  alert  to  prevent.  Such  sores  are  usually  due  to  faulty 
nursing  and  in  such  cases  should  be  regarded  as  a dis- 
grace to  the  one  in  charge.  The  first  sign  of  a bed-sore 
is  redness  wdiich  does  not  disappear  when  pressure  is 
removed.  Sometimes  the  patient  complains  of  a prick- 
ing sensation  as  if  he  were  lying  on  something  rough; 
but  often  the  patient  makes  no  complaint  at  all,  and 
unless  the  home  nurse  is  watchful,  a bed-sore  may  be 
far  advanced  before  it  is  suspected. 

The  patient  who  is  delirious  or  unable  to  control  the 
discharges  from  the  bowels  and  the  bladder  is  a case 
always  to  be  watched.  After  lying  for  even  a short  time 
in  a bed  that  is  wet  or  soiled  the  skin  becomes  softened 
and  breaks  very  easily.  Germs  enter  such  a wound  at 
once,  and  very  quickly  a bed-sore  occurs. 

Resting  too  long  in  one  position  is  another  factor  con- 
tributing to  bed-sores  that  needs  constant  attention. 


THE  PERSONAL  CARE  OF  THE  INVALID 


61 


Even  If  the  patient  is  not  delirious,  he  is  often  too  weak 
to  make  the  exertion  necessary  to  turn  from  one  position 
to  another.  To  prevent  is  much  easier  than  to  cure. 
The  parts  on  which  bed-sores  are  most  likely  to  occur 
are:  the  back  at  the  end  of  the  spine,  the  hips,  shoulders, 
elbows,  or  ankles,  or  between  the  knees,  but  sores  may 
occur  on  any  part  when  conditions  are  favorable.  Daily 
examination  of  such  parts  should  be  made  in  cases  of 
serious  or  prolonged  illness. 

Preventive  measures  consist  in  keeping  the  patient  dry 
and  clean,  his  bed  free  from  crumbs,  wrinkles  or  lumps 
and  in  relieving  so  far  as  possible,  the  pressure  on  parts 


Fig  20. — Invalid’s  cushion. 


in  which  a bed-sore  is  threatened.  A solution  for  hard- 
ening the  skin  is  also  helpful.  Alum  dissolved  in  alcohol 
is  often  used  for  this  purpose,  the  part  being  first  washed 
with  warm  water  and  soap,  and  dried.  Keeping  the 
parts  clean  and  dry  and  relieving  the  pressure  are, 
however,  much  more  important  than  any  drug  or  sub- 
stance that  can  be  applied. 

To  relieve  pressure,  circular  cushions  or  air  pillows  are 
used.  These  cushions  are  shaped  much  like  a doughnut 
with  a hole  in  the  centre.  Rubber  cushions  filled  with 
air  are  desirable,  but  a home-made  substitute  may  be 
made  of  a small  roll  of  cotton  batting  made  into  a circle 
and  covered  with  a roller  bandage.  The  point  at  which 


62 


HOME  NURSE^S  HAND-BOOK 


the  bed  sore  is  threatened  is  placed  over  the  hole  in  the 
centre.  Small  pads  of  cotton  batting  are  sometimes 
bound  with  a few  turns  of  a bandage  over  the  ankle,  heel 
or  elbow,  thus  making  soft  cushions  for  the  parts  threat- 
ened. A similar  pad  may  be  placed  between  the  knees 
when  there  is  liability  of  a sore  developing  there.  When 
the  skin  breaks,  a bed-sore  becomes  an  open  wound  and 
great  care  is  needed  to  prevent  its  becoming  a serious 
complication  of  any  illness.  The  nurse  should  not  hes- 
itate to  tell  the  doctor  when  a bed-sore  is  threatened. 
After  a wound  is  formed  he  will  give  directions  as  to 
how  it  should  be  dressed  and  cared  for. 

A hed-pan  if  not  carefully  managed  may  help  to  form 
a bed-sore.  There  are  two  or  three  kinds  of  bed-pans 
in  common  use.  When  the  so-called  slipper  bed-pan  is 
used,  in  cases  of  prolonged  illnes,  much  care  is  needed  or 
its  use  may  help  to  form  a bed-sore  on  the  lower  part  of 
the  back.  The  patient  should  not  be  left  on  it  a minute 
longer  than  is  necessary,  and  the  parts  should  be  care- 
fully cleansed  and  dried  after  its  use.  A pad  made  of 
cotton  may  be  slipped  over  the  part  on  which  the  back 
rests  to  ease  the  pressure.  In  cold  weather  the  bed-pan 
should  be  warmed  before  placing  it  under  the  patient. 
It  should  be  covered  with  a cloth  when  being  carried  to 
be  emptied. 

Points  to  be  Remembered. — Humor  the  patient  when 
it  makes  no  difference. 

In  almost  all  forms  of  sickness  it  is  necessary  at  some 
time  to  apply  heat  to  the  feet.  Cold  feet  are  a common 
source  of  discomfort. 

Be  sure  that  the  bricks  or  hot  water  bottles  are  not 
hot  enough  to  burn.  If  too  hot  the  heat  is  more  un- 
comfortable than  the  trouble  it  is  to  remedy. 

Do  not  leave  heating  devices  close  to  an  unconscious 
or  delirious  person.  Very  bad  l:)urns  have  been  caused 
by  carelessness  al)out  this  point. 

The  gentle  art  of  making  a patient  comfortal)le  in- 
cludes a thousand  methods  which  have  never  been  pat- 


THE  PERSONAL  CARE  OF  THE  INVALID 


63 


ented  and  cannot  be  enumerated.  Try  to  discover 
just  what  method  is  best  adapted  to  each  individual 
patient.  No  service  is  too  small  or  too  lowly  if  it  adds 
to  a patient^s  comfort. 

In  propping  a patient  up  in  bed  be  sure  that  the 
pillows  are  placed  close  down  to  the  base  of  the  spine, 
and  that  the  support  is  even. 

Bed-sores  are  almost  always  preventable  by  careful 
nursing.  They  are  to  be  feared  in  all  cases  of  pro- 
tracted illness. 

A bed-sore  may  become  infected  and  prove  a serious 
complication.  Be  sure  to  report  to  the  doctor  when 
there  seems  to  be  danger  of  one  forming. 

Careless  management  of  the  bed-pan  may  contribute 
to  the  formation  of  a bed-sore. 

REVIEW  QUESTIONS. 

1.  In  applying  heat  to  the  feet  what  precaution  would  you  use? 
What  special  precautions  in  the  care  of  hot- water  bottles  ? 

2.  Mention  some  of  the  general  measures  you  would  use  to  add 
to  the  comfort  of  the  patient. 

3.  Describe  some  of  the  general  measures  you  would  use  in  cases 
of  difficult  breathing. 

4.  Give  some  reasons  why  watch  the  bladder’’  is  a necessary 
precaution  even  when  the  patient  can  pass  urine. 

5.  Tell  how  you  would  prop  a patient  up  in  bed. 

6.  In  what  kinds  of  patients  are  bed-sores  most  likely  to  occur  ? 

7.  How  would  you  know  that  a bed-sore  was  threatened  ? 

8.  Name  three  common  causes  of  bed-sores? 

9.  What  measures  would  you  use  to  prevent  bed-sores : 

10.  Describe  some  devices  for  relieving  pressure  when  a bed- 
sore is  threatened. 


CHAPTER  VII. 


FEEDING  THE  SICK. 

Demonstration  and  Practice  Work. — Methods  of  varying  the  mik 
diet.  The  making  of  albumin  water  and  junket.  How  to  pas- 
teurize milk.  Pre-digestion  of  milk. 

Our  bodies  contain  certain  elements,  and  these  ele- 
ments must  be  contained  in  the  food  we  eat  in  order  that 
our  bodies  may  be  kept  in  good  repair.  This  is  true 
in  both  sickness  and  health.  See  page  13. 

Food  is  more  important  than  medicines  in  most  forms 
of  sickness.  Only  as  the  body  is  able  to  digest  and 
absorb  suitable  nourishment,  can  the  diseased  organs 
or  tissues  be  replaced  by  healthy  tissues.  The  bod}^ 
must  be  built  up  and  renewed  from  the  products  of  the 
kitchen  rather  than  of  the  drug  shop.  This  is  one 
lesson  which  home  nurses  find  it  hard  to  learn.  To  be 
successful  in  cooking  for  and  feeding  the  sick  is  an 
accomplishment  of  which  any  girl  should  be  proud. 

Tissue-building  foods: 


Milk. 

Fish. 

Peas. 

Eggs. 

Cheese. 

Lentils. 

Meat. 

Beans. 

Peanuts. 

Heat-  and  force-producing  foods: 

Cereals. 

Potatoes. 

Fats. 

Corn. 

Tapioca. 

Sugar. 

Rice. 

Sago. 

Honey. 

Vegetables  containing  little  or  no 

starch: 

Cabbage. 

Parsnips. 

Lettuce. 

Asparagus. 

Turnips. 

Radishes. 

Spinach. 

Egg-plant. 

Onions. 

Celery. 

Artichokes. 

Rhubarl). 

Green  l)eans. 

Tomatoes. 

Cauliflower. 

Squash. 

Cucumbers. 

64 

Fruits. 

FEEDING  THE  SICK 


65 


It  should  always  be  remembered  that  in  most  diseases 
where  there  is  fever,  the  organs  which  prepare  the  diges- 
tive fluids  are  weakened  and  incapable  of  digesting  many 
foods  that  are  useful  in  health. 

Waste  matter  also  has  a tendency  to  accumulate  in 
the  body.  These  waste  products  act  as  poison  in  the 
system.  The  foods  given  should  therefore  be  such  that 
they  will  not  clog  up  the  system,  and  that  the  waste 
may  be  easily  thrown  off. 

The  physician  in  most  cases  will  give  general  direc- 
tions as  to  what  food  may  be  given  during  illness.  The 
nurse  is  expected  to  prepare  and  give  it  so  that  it  will 
be  easily  digested,  and  at  the  same  time  be  pleasing  to 
the  patient. 

General  Principles  of  Feeding. — 1.  In  diseases  in 
which  fever  is  present  it  is  generally  agreed  that  the 
food  should  be  in  fluid  form  so  that  it  can  be  quickly 
digested  and  absorbed. 

2.  It  should  be  given  in  small  quantities  and  at  com- 
paratively short  intervals. 

3.  It  should  be  of  such  form  and  quality  as  to  con- 
tribute the  greatest  amount  of  nourishment  with  the 
least  tax  on  the  digestive  organs. 

4.  Plenty  of  water  should  be  given  to  replace  the 
fluids  in  the  body,  which  are  lessened  by  fever,  and  also 
to  assist  in  flushing  the  system  and  carrying  off  waste. 

5.  Foods  should  be  avoided  that  are  likely  to  disagree 
with  the  present  condition  of  the  patient. 

These  principles  and  rules  apply  especially  to  feeding 
while  there  is  fever.  Milk,  animal  broth,  eggs  and  gelatin 
are  the  foods  chiefly  relied  on  while  there  is  much  fever 
present. 

Milk  stands  first  as, a food  for  invalids,  in  general 
desirability  and  value  as  nourishment.  Every  home 
nurse  should  study  how  to  give  it  so  that  it  will  not 
disagree,  and  will  be  easily  digested.  It  is  not  sufficient 
to  simply  carry  a glass  of  milk  to  the  patient  and  let 
him  swallow  it  as  rapidly  as  possible.  There  is  no 
5 


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better  way  to  make  sure  it  will  disagree.  Teach  the 
patient  to  sip  milk  slowly  so  that  it  may  become 
thoroughly  mixed  with  the  saliva.  Remember  that 
milk  is  a food  which  though  it  is  a fluid  outside  the 
body  quickly  becomes  a solid  when  it  reaches  the 
stomach. 

Milk  which  is  too  hastily  swallowed  is  liable  to  form 
into  tough  indigestible  curds  in  the  stomach.  These 
cause  pain  and  are  often  vomited  or  passed  through 
the  bowels  without  being  digested.  Such  feeding  does 
the  patient  harm  rather  than  good. 

If  the  patient  does  not  like  milk  or  is  sure  it  will  dis- 
agree with  him  and  the  doctor  wishes  him  to  take  it,  try 
at  first  giving  a little  at  a time,  from  one  or  two  tea- 
spoonfuls, and  give  it  either  ice  cold  or  very  hot.  Re- 
peat about  every  fifteen  minutes  for  a few  hours,  when 
the  quantity  may  be  increased,  and  the  intervals  be- 
tween nourishment  made  longer. 

It  is  not  a good  plan,  as  a rule,  to  give  milk  at  or  near 
the  same  time  that  medicine  is  given,  nor  to  mix  milk 
with  medicine  of  any  kind  if  there  is  a tendency  for  it  to 
disagree. 

Junket  is  milk  which  has  been  partly  digested  by 
rennet.  It  is  one  of  the  best  methods  of  giving  milk  in 
many  cases.  Use  a flavor  which  the  patient  likes  and 
alternate  it  with  milk  given  in  fluid  form  for  a change. 
Milk  that  has  been  boiled,  condensed  or  evaporated 
should  not  be  used  for  junkets.  Junket  tablets  with 
directions  for  use  are  obtainable  at  most  good  drug 
stores. 

Milk  and  gelatin  combined  make  a smooth,  bland 
easily  digested  custard,  which  most  patients  on  a re- 
stricted diet  will  enjoy,  and  may  safely  have. 

The  clear  white  gelatin  made  into  a jelly  and  unsweet- 
ened is  occasionally  added  to  food  for  infants  and  inva- 
lids— a teaspoonful  stirred  into  a glass  of  milk. 

Milk  ami  coffee  make  another  combination  much 
enjoyed  by  some  patients.  Heat  a small  cup  of  milk  to 


FEEDING  THE  SICK 


67 


boiling  point  and  add  about  the  same  amount  of  strong 
hot  coffee. 

Starchy  substances  in  the  form  of  strained  gruels  are 
frequently  given  in  milk  both  for  variety,  and  because 
they  are  more  easily  digested  in  some  cases. 

Barley  water  is  recommended  frequently  in  diluting 
milk  in  cases  of  diarrhea,  and  oatmeal  water  when  con- 
stipation exists. 

A cracker  or  a piece  of  bread  given  with  milk  is  an 
aid  to  its  digestion  in  cases  where  it  is  likely  to  cause 
distress  by  forming  hard  lumps  in  the  stomach.  When 
solid  food  is  not  forbidden,  and  especially  with  children, 
this  point  may  often  be  made  use  of  to  advantage. 

Lime  water  is  added  to  milk  mainly  to  prevent  the  milk 
from  curdling  in  large  lumps  after  it  reaches  the  stomach. 

Salt — a saltspoonful  to  a glass  of  milk,  is  sometimes 
added  to  improve  its  digestibility.  ^^It  renders  it  less 
likely  to  cause  biliousness.^^  Thompson. 

Bicarbonate  of  soda  or  ordinary  baking  soda  (about 
what  might  be  heaped  on  a dime)  to  a glass  of  milk  is 
occasionally  put  into  the  milk  to  correct  excessive 
acidity  of  the  stomach. 

Vichy,  or  plain  bottled  soda  water  are  often  com- 
bined with  milk.  These  relieve  the  flatness  of  the  milk, 
and  tend  to  prevent  the  disagreeable  after-taste  in  the 
mouth  of  which  some  patients  complain. 

Impure  Milk. — As  milk  forms  the  main  (often  the 
whole)  food  for  sick  people,  infants  and  small  children, 
it  is  highly  important  that  it  should  be  as  free  from  im- 
purities as  it  is  possible  to  secure,  and  that  after  its 
delivery  it  be  kept  in  a cool  place  and  in  covered  clean 
receptacles.  Many  cases  of  tuberculosis,  diphtheria, 
typhoid  fever,  and  other  communicable  diseases  have 
been  traced  to  the  milk  supplyo  It  is  also  a common 
cause  of  infantile  diarrhea. 

Pasteurized  Milk. — Where  there  is  reason  to  suspect 
that  the  milk  is  not  as  pure  as  it  should  be,  pasteuriza- 
tion is  frequently  resorted  to.  Pasteurizing  consists  in 


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heating  the  milk  to  about  167®  F.  and  keeping  it  at  that 
point  for  twenty  minutes.  This  has  the  effect  of  killing 
the  germs  most  commonly  found  in  milk  that  render  it 
dangerous.  A little  instrument  known  as  a pastometer 
has  been  designed  to  show  just  when  the  pasteurization 
temperature  has  been  reached.  It  is  inserted  in  the 
bottle  in  which  the  milk  is  heated.  When  the  tempera- 
ture of  the  milk  reaches  pasteurization  point,  a needle  is 
automatically  thrown  up.  After  the  milk  has  been  kept 
at  that  point  for  about  twenty  minutes  it  should  then  be 
cooled  and  placed  on  ice. 

Sterilized  milk  is  milk  which  has  been  heated  to  the 
boiling  point,  212®  F.  Many  medical  authorities  claim 
that  sterilized  milk  is  more  difficult  to  digest  than  raw 
milk,  and  also  that  certain  of  the  nourishing  properties 
are  lessened. 

Predigestion  of  milk  is  accomplished  by  adding  pancrea- 
tin  or  some  other  digestive  substance  to  the  milk  before  it 
enters  the  body.  In  all  cases  where  this  is  necessary  to 
be  done  a physician  should  be  asked  for  definite  direc- 
tions as  to  what  digestive  preparation  is  to  be  used. 
Full  directions  accompany  most  of  the  preparations 
commonly  used  for  digesting  milk. 

Buttermilk  is  more  agreeable  to  many  patients  than 
whole  or  skimmed  milk  and  may  safely  be  alternated 
with  ordinary  sweet  milk  in  most  cases.  It  contains 
practically  the  same  amount  of  nourishment  as  skimmed 
milk.  It  lacks  the  fat  of  whole  milk. 

Broths  and  beef  tea  vary  in  their  food  value,  and  often 
contain  very  little  real  nourishment,  but  when  properly 
made  are  useful  invalid  foods.  They  are  slightly  stimu- 
lating and  help  in  many  cases  by  affording  variety,  even 
if  the  amount  of  nourishment  in  them  is  not  great.  If 
continued  for  any  consideral)le  time  they  are  apt  to 
cause  diarrhea,  and  as  a rule  are  best  avoided  when 
diarrhea  is  ))resent  or  there  is  a tendency  to  it. 

(ielatin  jelhj  made  with  different  flavors  according  to 
directions  accompanying  the  package  can  be  safely 


FEEDING  THE  SICK 


69 


used  in  most  cases  in  which  a fluid  or  light  diet  is  pre- 
scribed. A kind  known  as  ^^minute  gelatin  sets  quickly 
and  can  be  obtained  from  ordinary  groceries. 

Albumin  water  which  is  made  by  combining  the  white 
of  an  egg  with  water  and  usually  some  fruit  juice  and 
sugar  for  flavoring,  can  often  be  taken  by  invalids  with 
weakened  digestive  powers  when  the  whole  egg  could  not 
be  digested.  It  is  much  used  in  protracted  fevers,  being 
given  alternately  with  milk.  Add  the  fruit  juice  and 
sugar  to  the  unbeaten  white  of  the  egg  and  beat  or  stir 
until  thoroughly  blended.  Then  add  the  water. 

Eggs  contain  a large  amount  of  nourishment  and  are 
especially  valuable  in  convalescence  after  wasting  dis- 
eases. The  yolk  of  the  egg  contains  more  fat  and  more 
actual  nourishment  than  the  white,  but  is  less  easily 
digested. 

Feeding  in  Typhoid  Fever. — There  is  probably  no  one 
disease  which  causes  the  home  nurse  more  perplexity 
in  regard  to  diet  than  typhoid  fever,  especially  if  the 
patient  does  not  take  kindly  to  milk.  A much  more 
varied  and  liberal  diet  is  now  allowed  by  physicians 
in  this  disease  than  was  the  case  years  ago,  though 
much  care  and  judgment  needs  to  be  exercised.  If  the 
patient  can  take  broths,  a good  variety  can  be  obtained 
in  clear  soups  by  cooking  in  the  soup  fresh  vegetables 
in  a muslin  bag,  varying  the  flavor  from  day  to  day. 
Gelatin  and  white  of  egg  and  fruit  juices  afford  a wide 
range  of  choice  in  methods  of  preparation.  A couple 
of  days’  menus  might  be  as  follows: 

6 A.  M.  Cup  of  coffee  made  with  one-half  milk,  the 
milk  being  heated  before  being  added. 

8 A.  M.  Broth. 

10  A.  M.  Dish  of  junket. 

Noon.  Orange  jelly  and  cup  of  weak  tea. 

2 p.  M.  Albumen  water  flavored  with  lemon  or 
grape  juice. 

4 p.  M.  Broth. 

6 p.  M.  Ice  cream  or  sherbet. 


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8 p.  M.  Broth  or  junket. 

10  p.  M.  Cup  of  cocoa. 

Midnight.  Glass  of  buttermilk  or  sweet  milk. 

Ice  cream  can  be  made  in  small  amounts  quickly  by 
using  a large  baking  powder  can  for  a freezer  and  packing 
it  in  a small  bucket  of  ice  and  salt. 

Snow  pudding  made  with  whites  of  eggs,  gelatin,  and 
water,  beaten  till  quite  stiff,  makes  an  attractive  dish 
for  very  ill  patients,  and  because  it  is  semisolid  and  can 
be  eaten  with  a spoon  is  likely  to  be  relished.  Dissolve 
2 tablespoonfuls  of  granulated  gelatin,  in  2 tablespoons 
of  cold  water;  add  sugar  to  taste  and  a tablespoon  of 
lemon  juice,  and  when  the  gelatin  is  dissolved,  a cupful 
of  hot  water,  stirring  all  the  time.  Set  in  a cold  place 
till  almost  firm.  Then  beat  into  the  gelatin,  the  white 
of  an  egg  beaten  stiffly.  Set  it  on  ice  till  quite  firm. 
This  melts  to  a fluid  when  in  the  mouth  and  can  be 
given  to  most  patients  suffering  from  fever  of  any  kind. 

Cottage  cheese  is  given  in  moderate  quantities  by  many 
physicians  to  patients  with  typhoid  fever  at  any  time 
throughout  the  disease. 

The  Care  of  Milk  in  the  Home.^ — Milk  is  a perishable 
food.  The  length  of  time  it  remains  sweet  depends 
largely  on  the  care  it  receives  after  delivery  to  the  con- 
sumer. Keep  it  clean,  cool  and  covered  and  it  should 
remain  sweet  during  the  24  hours  in  which  it  should  be 
used. 

Germs,  to  grow,  require  three  important  things, 
namely:  food,  moisture  and  moderate  heat.  Milk 
furnishes  food  and  moisture  and  the  room  air  furnishes 
the  necessary  warmth.  Milk  is  therefore  a very  good 
medium  for  the  growth  of  germs  if  not  kept  cold. 

Dust,  dirt  and  flies  are  the  carriers  through  which 
germs  get  into  milk.  Milk,  therefore,  should  be  pro- 
tected from  dust,  dirt  and  flies. 

Kemenil)er:  the  most  im])ortant  rule  about  the  care 

^ From  bulletin  of  New  York  Sanitary  Milk  Dealers’  Associa- 
tion. 


FEEDING  THE  SICK 


71 


of  milk  is:  keep  the  milk  clean,  keep  it  cold,  and  keep  it 
covered. 

Arrival  of  the  Daily  Supply. — 1.  Do  not  allow  milk  to 
stand  on  the  dumb-waiter,  stoop,  window  sill  or  other 
place  where  the  driver  leaves  it.  Place  it  promptly  in 
the  ice  box. 

2.  Keep  your  ice  box  cold.  Keep  it  well  stocked 
with  ice.  You  cannot  obtain  good  refrigeration  with- 
out a well  filled  ice  compartment. 

3.  Keep  your  refrigerator  clean.  Keep  it  free  from 
disagreeable  odors.  Milk  absorbs  unpleasant  odors 
very  readily.  Strong  smelling  foods  such  as  onions, 
garlic,  and  strong  cheeses,  should  not  be  kept  in  the 
same  compartment  with  milk  or  butter. 

4.  Where  ice  boxes  are  not  available,  some  make- 
shift arrangement  should  be  provided.  The  Depart- 
ment of  Health  has  recommended  the  following: 

An  emergency  ice  box  may  be  constructed  by  placing 
a piece  of  ice  in  a covered  tin  pail  or  bucket  having  a 
hole  in  the  bottom.  An  old  leaky  pail  will  answer. 

^Tlace  the  bottles  of  milk  in  direct  contact  with 
the  ice,  and  cover  the  whole  with  a heavy  cloth  or 
blanket.  The  pail  may  be  kept  in  the  sink.^’ 

5.  The  Sanitary  Code  provides  that  milk  should 
be  kept  at  50°  F.  or  lower.  Milk  purchased  from  stores 
should  be  delivered  in  a clean  condition  and  at  or  below 
the  required  temperature. 

6.  Keep  the  milk  prepared  for  infant  feeding  in 
nursery  bottles  in  the  ice  box  until  just  before  using. 
The  practice  of  heating  the  baby^s  milk  at  evening 
and  keeping  it  warm  until  the  night  or  early  morning 
feeding  is  very  bad.  The  heat  thus  maintained  is 
most  favorable  to  the  growth  of  germs. 

Use  and  Protection. — 1.  Return  promptly  to  the  ice  box 
any  unused  portion  of  milk.  Standing  in  the  warm 
room  will  greatly  hasten  the  growth  of  germs.  Keep 
the  milk  tightly  covered,  so  that  dust,  dirt  and  flies  may 
not  enter. 


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2.  Wipe  the  mouth  of  the  bottle  carefully  with  a 
clean  towel  before  removing  the  cap.  Use  a sharp 
pronged  instrument,  inserted  diagonally  into  the  center 
of  the  cap,  to  remove  it.  Keep  this  instrument  clean. 
Lift  the  cap  with  care  and  rinse  it  in  clean  running 
water  before  replacing  it. 

Do  not  use  large  steel  knives,  shears  or  other  heavy 
implements  to  remove  the  cap.  Such  instruments 
splinter  the  glass,  particles  of  which  may  enter  the  milk. 

Many  dealers,  oh  request,  will  supply  convenient 
implements  for  this  purpose. 

3.  Pour  the  milk  into  clean  receptacles.  Dirty 
vessels  will  as  readily  contaminate  the  milk  as  will 
dust,  dirt  and  flies. 

Place  milk  dipped  from  cans  or  tanks  only  in  clean 
covered  pails  or  other  covered  receptacles. 

4.  Mix  the  milk  well  before  using.  Inverting  the 
bottle  rapidly  two  or  three  times  will  accomplish  this. 
Cream  separates  and  rises  to  the  top,  making  this 
necessary. 

5.  Pour  only  enough  milk  from  the  bottle  for  the 
the  specific  use.  Do  not  put  any  unused  portion  back 
with  the  milk  from  which  it  was  taken,  but  place  it  in 
the  ice  box  in  another  covered  vessel. 

6.  Do  not  keep  more  than  one  day^s  supply  of  milk 
at  a time.  Order  a fresh  supply  daily. 

Treatment  of  Empty  Containers — 1.  Wash  the  milk 
bottles  before  returning  them  to  your  dealer.  This  is 
required  by  law.  The  proper  way  to  wash  a milk  bottle 
is  to  first  rinse  it  thoroughly  with  cold  water.  When 
all  the  milky  film  has  been  removed  from  the  inside, 
then  wash  carefully  with  very  hot  water.  All  vessels 
used  for  holding  milk  or  cream  should  be  cleansed  in  the 
same  manner. 

2.  Do  not  use  milk  bottles  for  any  other  purpose 
than  the  holding  of  milk  or  cream.  Such  other  use  is 
prohibited  by  law. 

3.  Rinse  nursery  bottles  and  nipples  in  cold  water 


FEEDING  THE  SICK 


73 


and  wash  in  boiling  water  immediately  after  each  feeding. 
Turn  the  nipples  inside  out  and  thoroughly  cleanse. 
Rinse  the  bottles  and  nipples  again  in  boiling  water 
before  using. 

4.  Return  empty  bottles  to  the  dealer  daily  after 
cleaning. 

Legal  Requirements. — The  law  covering  the  cleaning 
and  use  of  bottles  reads  as  follows: 

SANITARY  CODE. 

Sec.  183.  Milk  Receptacles. — It  shall  be  the  duty 
of  all  persons  having  in  their  possession  bottles,  cans  or 
other  receptacles  contaming  milk  or  cream,  which  are 
used  in  the  transportation  and  delivery  of  milk  or  cream, 
to  clean  or  cause  them  to.  be  cleaned  immediately  upon 
emptying. 

No  person  shall  use  or  cause  or  allow  to  be  used  any 
receptacle  which  is  used  in  the  transportation  and 
delivery  of  milk  or  cream  for  any  purpose  whatsoever 
other  than  the  holding  of  milk  or  cream;  nor  shall  any 
person  receive  or  have  in  his  possession  any  such  recep- 
tacle which  has  not  been  washed  after  holding  milk  or 
cream  or  which  is  unclean  in  any  way.^^ 

Finally. — Keep  the  milk  clean,  keep  it  cold  and  keep 
it  covered. 

Points  to  be  Remembered. — It  is  not  the  food  which  a 
sick  person  takes,  but  only  that  which  can  be  digested 
and  assimilated  which  becomes  a help  to  his  recovery. 

The  manner  in  which  food  is  prepared  and  served  has 
a great  deal  to  do  with  its  digestion. 

Food  is  a far  more  important  lactor  in  many  diseases 
than  drugs. 

Diseased  and  weakened  tissues  of  the  body  must  be 
replaced  by  new  healthy  tissues.  This  new  tissue 
must  be  formed  from  the  food. 

Enforced  inactivity  makes  it  more  difficult  for  the 
body  to  throw  off  the  waste  that  is  being  constantly 
formed. 


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HOME  nurse's  hand-book 


Food  for  the  sick  should  be  chosen  with  a view  to 
lessening  the  amount  of  waste  and  affording  the  greatest 
amount  of  nourishment  in  easily  digestible  form. 

In  nearly  all  sickness  accompanied  by  fever  it  is  im- 
portant to  give  the  patient  plenty  of  water  to  drink. 

Milk  is  a food  rather  than  a beverage  and  should  be 
used  as  such.  It  is  one  of  the  most  valuable  of  all  foods 
in  sickness. 

There  is  much  to  learn  about  how  to  give  milk  to  the 
sick  so  that  it  will  be  easily  digested.  The  home  nurse 
should  be  careful  about  the  little  details  in  giving  milk. 

Do  not  give  milk  and  medicine  at  the  same  time  unless 
told  to  do  so  by  the  doctor. 

Buttermilk  often  agrees  better  with  some  patients 
than  sweet  milk.  In  most  cases  of  prolonged  sickness 
it  can  be  used  to  alternate  with  sweet  milk. 

Many  sick  people  can  be  persuaded  into  eating  junket 
when  they  would  protest  against  taking  milk.  It  can 
nearly  always  be  used  to  give  variety  to  a milk  diet  in 
an  invalid. 

In  cities,  the  care  of  the  milk  and  the  milk  bottles  is 
an  important  duty  which  the  home  nurse  cannot  afford 
to  be  careless  about. 

REVIEW  QUESTIONS. 

1.  State  the  general  principles  that  should  govern  the  feeding 
of  the  sick. 

2.  What  foods  are  especially  useful  when  fever  is  present? 

3.  Mention  some  general  precautions  which  should  be  observed 
in  giving  milk  to  the  sick. 

4.  When  a patient  is  on  a milk  diet  what  can  be  done  to  give  it 
variety? 

5.  Why  are  barley  water  and  oatmeal  water  sometimes  added  to 
milk  for  infants  and  invalids? 

6.  What  effect  does  lime  water  have  when  added  to  milk? 

7.  What  is  meant  by  the  term  '^pasteurization?”  Why  is  pas- 
teurization needed? 

8.  How  is  pre-digestion  of  milk  accomplished? 

9.  What  element  of  milk  is  lacking  in  l)uttermilk? 

10.  What  is  albumin  water  and  how  would  you  prepare  it? 


FEEDING  THE  SICK 


75 


11.  Why  is  scrupulous  care  in  regard  to  cleanliness  of  milk  im- 
portant? 

12.  What  are  the  most  important  rules  regarding  the  care  of  milk 
in  the  home? 

13.  Show  how  disease  may  be  spread  by  means  of  milk-bottles. 

14.  How  should  empty  milk-bottles  be  cared  for  in  the  home? 


CHAPTER  VIII. 


FEEDING  THE  SICK  (continued). 

Demonstration  and  Practice  Work, — Setting  a tray.  Methods  of 
serving  liquid,  semi-solid  and  full  diet. 

The  manner  in  which  food  is  cooked  and  served  has 
much  to  do  with  the  appetite  for  it  and  appetite  has 
much  to  do  with  digestion. 

Kinds  of  Invalid  Diet. — In  the  feeding  of  invalids 
there  are  four  grades  of  diet  recognized,  besides  the  so- 
called  special  or  restricted  diets  which  are  required  in 
dealing  with  such  diseases  as  diabetes,  various  forms  of 
digestive  diseases,  and  others  in  which  the  diet  is  the 
most  important  feature  in  the  treatment. 

1.  Fluid  or  liquid  diet. 

2.  Semi-solid  diet. 

3.  Light  diet. 

4.  Regular  or  ^^fulF^  diet. 

Fluid  Diet. — ^For  patients  on  fluid  or  liquid  diet  such 
foods  as  the  following,  are  included:  beef-tea,  beef-juice, 
chicken  broth,  mutton  broth,  gelatin,  ice  q^eam,  and 
water  ices,  barley  water,  cocoa,  albumen  water,  certain 
forms  of  strainecl  gruel,  buttermilk,  and  milk  served  in 
its  natural  state,  or  in  its  almost  numberless  combina- 
tions that  vary  the  flavor. 

Semi-solid  Diet. — For  patients  on  semi-solid  diet  such 
foods  are  suitable  as  oatmeal  gruel,  or  well  cooked  cereals, 
custards,  egg  nogs,  blanc  mange,  rice,  tapioca,  sago,  prune 
or  apple  whips,  milk  toast,  soft  boiled  eggs,  and  bread 
and  milk — these  in  addition  to  the  foods  mentioned  in  the 
liquid  diet  list. 

Light  Diet. — ^l^or  patients  on  light  diet  such  additions 
are  made  as  bread,  crackers,  toasts,  some  fruits,  certain 

76 


A very  light  diet  tray. 


For  the  patient  on  light  diet. 


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FEEDING  THE  SICK 


77 


kinds  of  fish  such  as  oysters,  clams,  and  the  white- 
fleshed  fishes,  poultry,  and  game,  all  meals  being  served 
in  small  quantities. 

Regular  diet  may  include  any  of  the  above  articles  with 
beef,  mutton  and  other  meats  added,  certain  vegetables, 
and  all  fruits. 

Convalescent  Diet  Suggestions, — ^For  patients  in  the  first 
stage  of  convalescence  those  who  have  weakened  digestive 
powers  especially,  fish,  chicken  and  the  shorter-fibered 
meats  are  usually  served  in  small  quantities,  before  beef, 
mutton,  and  other  more  difficult  meats  to  digest.  Many 
articles  that  are  permitted  in  health  have  no  place  in 
the  invalid^s  bill  of  fare.  Boiled  cabbage  or  cucumber 
pickles  or  boiled  dumplings,  for  instance,  are  much 
better  not  served  to  the  average  invalid,  even  though  the 
doctor  may  have  given  permission  for  the  patient  to  eat 
anything.  Even  though  digestion  is  not  seriously  im- 
paired, the  general  functions  of  the  body  are  sluggish 
through  lack  of  exercise,  and  it  is  unwise  to  put  un- 
necessary work  on  the  organs  that  throw  off  waste 
matter. 

Food  Preparation  and  Serving. — It  should  be  borne  in 
mind  that  because  the  range  of  foods  admissible  in  the 
invalid’s  dietary  is  limited,  special  care  must  be  used  in 
the  preparation  of  the  materials  allowed,  so  that  no  care- 
lessness or  failure  on  the  part  of  the  nurse  shall  spoil 
the  meal  or  cause  a distaste  for  foods,  or  which  would  tend 
to  monotony,  when  every  effort  should  be  made  to  secure 
variety.  To  give  variety  while  adhering  to  simple, 
easily  digested  foods,  to  excite  appetite,  and  at  the  same 
time  avoid  the  use  of  indigestibles  ” which  the  invalid 
often  craves,  calls  for  skill  and  good  judgment. 

In  no  other  part  of  nursing  do  little  things  count  for 
more,  and  the  importance  of  the  little  things  is  rarely 
sufficiently  appreciated  until  years  of  experience  have 
been  gained.  It  has  been  a source  of  astonishment  in 
dealing  with  nurses  to  find  how  few  there  are  who  on 
beginning  their  training  know  how  to  prepare  and  serve 


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a cup  of  tea,  a piece  of  toast,  or  an  egg  so  that  the  result 
could  be  pronounced  ^'exactly  right/'  The  same  is  true 
of  home  nurses. 

Toast  and  tea  are  the  first  thought  in  invalid  feeding 
with  many  people.  They  seem  such  simple  things  to 
prepare,  yet  there  are  many  details  to  be  remembered 
in  getting  even  this  simple  meal.  A good  deal  of  the 
time  the  toast  served  to  invalids  is  either  burnt,  half 
done,  or  soggy,  buttered  over-much,  or  in  patches,  and 
served  in  slices  so  that  the  patient  cannot  possibly 
manage  to  eat  it  without  getting  his  hands  well  greased. 
It  would  cost  no  more  of  either  time  or  money  to  toast 
it  a golden  brown,  put  the  right  amount  of  butter  on 
it,  and  serve  it  cut  in  squares  between  hot  plates. 

Quite  as  glaring  and  unnecessary  failures  are  seen  in  the 
making  and  serving  of  a cup  of  tea.  It  is  very  often 
either  made  with  water  which  was  not  boiling  when 
poured  on  the  tea,  or  the  tea  itself  was  allowed  to  boil;  a 
cup  of  tea  without  a cover  over  it  is  sometimes  poured  in 
the  kitchen  and  allowed  to  stand  cooling  while  the  re- 
mainder of  the  meal  was  served,  or  carried  through  a 
draughty  hall  or  two  till  it  reached  the  patient  luke- 
warm. The  careful  home  nurse  will  see  that  these 
blunders  do  not  occur  when  she  is  in  charge. 

Essentials  to  Success. — These  would  include  a great 
many  details,  but  the  very  first  is  cleanliness. 

1.  Cleanliness  of  food,  of  utensils  used  in  cooking,  of  all 
dishes  used  in  serving,  of  tray  linen,  of  the  patient's  hands 
and  general  surroundings. 

2.  Neatness, — Next  would  come  neatness.  A meal 
and  surroundings  may  be  clean,  but  the  tray  be  far  from 
neatly  or  carefully  set. 

3.  Quality  of  Food. — Food  supplies  should  be  the  best 
quality  obtainable;  they  should  be  fresh,  there  should  1)C 
as  much  variety  as  is  permissilde. 

4.  Preparation  of  Food. — The  methods  used  should  l)e 
simple  and  the  foods  should  be  freshly  cooked.  Fried 
foods  are  not  usually  desirable  for  invalids.  The  sea- 


The  patient’s  convenience  would  have  been  promoted  by  having  the 
teapot  on  this  tray  in  the  upper  right-hand  corner,  and  the  teacup  imme- 
diately in  front  of  it  in  line  with  the  plate. 


A luncheon  tray  (Good  Health). 


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soiling  and  flavoring  should  accord  as  far  as  possible  with 
the  patient^s  tastes.  Usually  in  sickness  the  sense  of 
taste  is  very  acute,  and  less  seasoning  is  needed.  Strong 
flavors  should  be  avoided.  Fat  should  be  carefully 
removed  before  serving  broths.  Gravies  containing  much 
grease  are  undesirable  for  invalids  whose  digestion  is  at 
all  impaired.  Foods  twice  cooked  or  warmed  over  should, 
as  a rule,  be  avoided. 

5.  Temperature  of  food  is  exceedingly  important.  Hot 
foods  should  be  served  hot,  but  not  so  hot  that  the  patient 
has  to  wait  for  them  to  cool  before  he  can  eat.  Hot  food 
should  be  covered  in  transit.  Cold  foods  should  be  cold, 
never  lukewarm. 

6.  Amount  of  Food. — Care  should  be  used  to  avoid 
serving  too  much  at  one  time  and  still  be  sure  that 
enough  has  been  given  to  satisfy,  unless  the  amount  is 
restricted. 

7.  Punctuality. — This  applies  to  both  cooking  and  serv- 
ing. Punctuality  and  regularity  in  serving  meals  to  an 
invalid  is  quite  as  necessary  as  in  giving  medicines.  In 
the  cooking  of  foods  the  time  needs  to  be  carefully  con- 
sidered. Custards  intended  to  be  served  cold  should  be 
cooked  long  enough  in  advance  for  the  cooling  to  take 
place.  Many  foods  are  spoiled  by  standing  after  being 
cooked.  A baked  potato  is  delicious  and  easily  digested 
when  cooked  just  right  and  promptly  served,  but  what 
is  more  unappetizing  than  a baked  potato  that  has  re- 
mained after  cooking  in  a slow  oven  till  it  is  soggy  and 
half  cold.  Tea  is  appetizing  if  made  with  freshly  boiled 
water  and  served  within  three  minutes  after  infusion. 
It  is  spoiled  if  prepared  too  long  in  advance.  These 
illustrations  might  be  multiplied  indefinitely.  Ices 
should  not  be  served  at  the  same  time  the  hot  food  is 
served. 

8.  Artistic  touches  count  for  much  more  in  the  serving 
of  meals  to  invalids  than  to  persons  in  health.  A patient 
who  had  no  desire  for  food  will  often  be  beguiled  into  tak- 
ing it,  and  will  relish  it  if  care  is  taken  to  present  it  in  the 


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HOME  NURSE^S  HAND-BOOK 


most  attractive  form.  Daintiness  about  serving  nourish- 
ment is  a great  help  in  attracting  the  eye  and  arousing 
interest.  The  prettiest  dishes  the  place  affords  should  be 
pressed  into  service,  and  when  possible  a change  of  pat- 
tern of  dishes  occasionally  is  worth  while.  If  a single 
article  or  two  of  food  only  are  to  be  served,  a small  tray 
rather  than  a large  one  should  be  used.  Care  should  be 
used  to  avoid  crowding  a tray  with  too  many  dishes.  It 
is  better  to  use  a second  tray  for  serving  dessert  or  fruit 
than  to  pile  too  much  on  one  tray  and  have  it  lack  in 
order  and  neatness.  When  the  sickroom  is  not  too  far 
from  the  kitchen,  serving  a meal  in  courses  is  a good  plan. 
As  far  as  possible  the  element  of  unexpectedness  should 
enter  into  a meal. 

Elaborate  garnishing  of  dishes  should  be  avoided,  but 
a touch  of  green  is  always  permissible,  and  lettuce,  parsley 
and  watercress  can  be  made  to  serve  quite  as  useful  a pur- 
pose in  the  sickroom  as  elsewhere. 

A spray  of  maiden-hair  fern  or  any  of  the  dainty  green 
effects  can  sometimes  be  used  for  decoration.  The  use  of 
flowers  on  a tray  is  laudable,  but  these  should  be  re- 
stricted to  a single  blossom  with  a touch  of  green  or  a full- 
blown flower  of  some  of  the  dainty  varieties.  However 
one  may  admire  an  American  beauty  rose  or  a peony,  or  a 
large  bouquet  of  any  kind  of  flowers,  they  are  out  of  place 
on  a tray.  A real  good  joke  or  an  apt  quotation,  clipped 
from  some  of  the  current  journals  and  laid  on  a tray,  will 
often  add  zest  to  a meal  and  divert  the  patient^s  thoughts 
from  himself. 

Cracked  or  unmatched  dishes  do  find  their  way  to  in- 
valids^ rooms  when  it  is  entirely  unnecessary.  Green 
cups  and  blue  saucers  are  hastily  set  together  by  care- 
less nurses,  but  such  blunders  destroy  any  artistic  effect 
the  tray  might  otherwise  have. 

A great  many  dainty  ways  of  serving  bread  have  been 
discovered,  and  the  same  is  true  of  potatoes  and  a great 
many  of  the  simple  foods. 

9.  Position  of  the  Patient, — This  is  a highly  important 


FEEDING  THE  SICK 


81 


detail  in  the  success  of  a meal.  He  should  be  made  as 
comfortable  as  possible,  and  put  in  the  most  convenient 
position  for  taking  the  food.  If  he  lies  on  his  side,  a small 
pillow  at  the  back  helps  to  support  him.  If  he  is  propped 
up,  the  pillows  should  be  tucked  in  snugly  at  the  base  of 
the  spine,  and  arranged  so  that  the  head  will  not  be 
thrown  forward  on  the  chest  nor  be  left  without  support. 
Grasping  of  any  part  of  the  body  with  the  finger-tips  is  an 
uncertain  and  uncomfortable  method  of  giving  support. 
If  the  hand  is  placed  behind  the  back,  the  full  breadth  of 
the  hands  should  be  used,  and  a small  pillow  between  the 
hands  and  the  patient  will  increase  the  comfort.  In 
short,  the  task  of  eating  and  drinking  should  be  made  as 
easy,  comfortable,  and  pleasant  to  the  patient  as  it  is 
possible  to  make  it. 

10.  General  Details, — A thoughtful  nurse  will  be  on  the 
alert  to  promote  the  convenience  and  comfort  of  the 
patient  in  every  way  during  the  meal.  She  will  not  allow 
a glass  or  cup  to  stand  in  a pool  of  fluid  in  the  saucer  and 
drip  every  time  it  is  carried  to  the  patient^ s mouth.  She 
will,  if  necessary,  cut  the  meat  into  small  pieces.  She 
will  assist  in  pouring  the  tea,  if  desirable,  in  removing 
dishes  used  to  keep  the  food  hot,  in  preparing  eggs  boiled 
in  shells  to  be  eaten;  in  removing  soiled  dishes  if  the  tray 
is  crowded.  She  will  at  once  remove  the  tray  after  the 
meal  has  been  taken.  She  will  not  be  guilty  of  leaving  milk 
or  food  standing  around  in  the  sickroom  in  the  hope 
the  patient  may  suddenly  desire  it.  Freshness,  as  far  as 
it  is  possible  to  obtain  it,  is  a good  rule  in  all  matters  relat- 
ing to  food. 

Feeding  of  Helpless  Patients. — If  the  patient^s  head 
has  to  be  raised  to  take  the  fluid  food,  it  should  be  done  by 
slipping  the  hand  underneath  the  pillow  and  raising  it 
rather  than  lifting  the  head  only.  Care  should  be  used 
never  to  have  the  glasses  or  cups  too  full. 

As  a rule,  when  a patient  craves  water  or  fluids  and  the 
amount  is  restricted,  it  is  better  to  give  it  in  a small  glass 
6 <s 


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which  is  nearly  filled  and  allow  him  to  empty  it,  than  to 
give  it  in  a large  glass  partly  filled,  which  he  is  not 
allowed  to  drain. 

Glass  tubes  used  for  feeding  should  be  bent.  Feeding 
cups  should  be  held  so  as  not  to  allow  the  fiuid  to  flow 
too  quickly. 

Unconscious  patients  should  have  only  fluid  food,  and 
it  should  be  administered  very  slowly,  from  a spoon  or 
medicine-dropper.  Only  a teaspoonful  at  a time  should 
be  given,  and  the  nurse  should  be  sure  it  is  swallowed 
before  giving  more.  If  less  than  1/2  teaspoonful  is  given 
it  is  not  likely  to  be  swallowed,  as  swallowing  is  not  in- 
duced by  a few  drops  of  fluid. 

When  rectal  feeding  is  necessary,  the  general  rules 
given  regarding  administration  of  medicine  by  rectum 
should  be  observed.  See  page  106. 

Points  to  be  Remembered. — There  are  many  points  to 
be  observed  even  in  preparing  and  serving  toast  and 
tea. 

Many  otherwise  good  meals  are  spoiled  because  the 
food  intended  to  be  hot  is  cold  or  nearly  so  when  it 
reaches  the  patient. 

Always  heat  the  dishes  used  in  sending  hot  food 
to  the  sickroom  and  always  cover  the  food  to  keep  it 
warm. 

Study  the  patient^s  likes  and  dislikes  in  regard  to 
flavors  in  food.  Try  to  make  the  food  attractive  to  the 
eye. 

Do  not  serve  too  much  food  at  one  time.  Better 
whet  the  appetite  with  a little  than  disgust  it  with  too 
much. 

Arrange  the  patient  as  comfortably  as  possible  when 
taking  a meal  in  bed. 

Watch  the  thousand  and  one  little  details  that  enter 
into  a successful,  enjoyable  meal  for  the  sick. 

A well  served  meal  on  a tray  calls  for  a good  taste  and 
good  judgment  in  its  arrangement. 


FEEDING  THE  SICK 


83 


REVIEW  QUESTIONS. 

1.  Name  the  four  classes  of  diet  commonly  recognized  in  invalid 
feeding. 

2.  Outline  the  chief  foods  which  are  included  in  each  class. 

3.  Mention  some  articles  of  food  which  as  a .rule  are  better 
not  served  to  patients  in  bed  when  full  diet  is  permitted,  and 
give  reasons. 

4.  What  rules  should  be  observed  in  preparing  a meal  of  toast 
and  tea?  Mention  some  common  mistakes  made  in  regard  to 
these  two  foods. 

5.  Outline  the  main  essentials  to  success  in  preparing  and  serving 
food  to  the  sick. 

6.  What  rules  should  always  be  regarded  in  serving  hot  foods  to 
invalids? 

7.  Mention  some  things  which  help  to  make  a tray  attractive. 

8.  How  may  the  home  nurse  promote  the  invalid’s  comfort  during 
a meal? 

9.  Give  some  rules  that  should  be  observed  in  feeding  helpless 
patients. 

10.  How  would  you  give  food  to  a patient  who  was  unconscious? 


CHAPTER  IX. 


SYMPTOMS  OF  SICKNESS. 

Demonstration  and  Practice  Work. — Temperature  taking  and 
chart  keeping.  Disinfection  and  care  of  clinical  thermometer. 

To  detect  signs  of  sickness  means  often  to  be  able  to 
prevent  sickness.  It  is  neither  wise  nor  necessary  to  be 
an  alarmist  and  imagine  that  a serious  disease  is  threat- 
ened whenever  a member  of  the  family  complains  of 
not  feeling  well.  But,  on  the  other  hand,  it  is  unwise  to 
shut  our  eyes  to  real  conditions  when  they  exist. 

Loss  of  Appetite, — One  of  the  first  signs  of  sickness 
which  the  home  nurse  will  observe  is  that  the  member  of 
the  family  misses  a meal  or  is  not  hungry.  This  symp- 
tom alone  is  rarely  serious.  In  ancient  days,  weekly  or 
periodical  fasts  were  enjoined,  and  we  may  well  believe 
that  these,  like  many  other  regulations  in  biblical  times, 
were  ordered  with  a view  to  improved  health  as  well 
as  to  promote  the  devotional  spirit.  If  the  loss  of  appe- 
tite continues,  if  it  is  accompanied  by  vomiting  or  other 
digestive  disturbances,  pain  or  fever,  then  the  home  nurse 
may  properly  be  concerned  about  it. 

Fever  Symptoms. — In  a great  many  diseases  the  early 
symptoms  are  similar.  There  is  a rise  of  body  tempera- 
ture, hot,  dry  skin,  thirst,  increased  pulse  rate,  loss  of 
appetite,  often  amounting  to  a disgust  for  food,  coated 
tongue,  headache,  pain  in  a greater  or  lesser  degree  in 
the  back  and  limbs,  with  very  often  more  or  less  diges- 
tive disorder.  When  most,  or  several,  of  these  symptoms 
exist  at  the  same  time  the  liome  nurse  should  be  on  the 
alert  for  other  signs  wliich  will  help  her  to  detect  the 
trouble  or  the  real  nature  of  the  ailment.  It  is  a common 
blunder  to  give  a name  to  these  symptoms,  and  say 

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is  going  to  have  scarlet  fever,  typhoid  fever  or  some 
other  serious  ailment,  when  often  the  real  trouble  is 
that  the  child  or  the  man  had  too  much  Christmas  or 
Thanksgiving  dinner.  Overloading  of  the  stomach  by 
children  at  holiday  seasons  has  often  produced  all  the 
symptoms  above  described.  In  fact  it  is  not  uncom- 
mon for  a child  to  become  so  poisoned  from  eating 
more  food  than  the  body  could  digest,  or  than  the 
organs  that  throw  off  waste  could  deal  with,  that 
he  has  lain  in  a stupor  for  two  or  three  days  with  high 
fever,  diarrhea,  vomiting,  rapid  pulse,  excessive  thirst, 
perhaps  all  the  fever  symptoms  mentioned.  Some- 
times constipation  instead  of  diarrhea  exists  and  when 
this  is  relieved  the  other  symptoms  will  soon  subside. 

Temperature. — The  body  is  all  the  time  producing 
heat.  The  foods  supplied  to  it  are  like  so  much  fuel 
consumed,  and  the  degree  of  heat  or  cold  is  called  the 
temperature. 

The  average  normal  temperature  of  the  human  body  is 
98.6®  F.,  but  it  varies  a fraction  of  a degree  both  accord- 
ing to  the  time  and  the  location  of  the  body.  The 
temperature  is  lower  in  the  morning  than  in  the  evening 
as  a rule,  and  if  taken  in  the  rectum  will  be  slightly 
higher  than  if  taken  in  the  mouth. 

Age  has  also  an  influence  on  temperature.  In  the 
child,  the  temperature  is  somewhat  higher  and  in  ad- 
vanced age  lower  than  the  normal  average.  In 
children  the  machinery  of  the  body  is  easily  thrown 
out  of  order.  Very  high  fever  often  comes  from  very 
slight  causes,  while  it  may  as  quickly  subside  as  it  arose. 

A clinical  thermometer  is  necessary  to  accurately 
ascertain  the  body  temperature.  These  thermometers 
are  made  to  register  usually  within  a range  of  about 
fifteen  degrees,  beginning  with  94®  or  95®  up  to  110®  F. 
The  thermometer  should  not  be  subjected  to  a greater 
heat  then  110®  F.,  which  usually  is  the  full  registering 
capacity.  A temperature  of  105®  F.,  may  be  regarded 
as  extremely  serious,  though  the  danger  depends  con- 


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siderably  on  the  nature  of  the  disease.  Likewise  at  the 
other  extreme  when  the  temperature  drops  below  97°  it 
ought  to  cause  alarm.  But  the  home  nurse  should  be 
sure  that  the  temperature  was  properly  taken,  for  mis- 
takes may  very  easily  be  made.  When  the  temperature 
rises  above  99°  F.  the  patient  should  be  watched,  and  if 
it  tends  to  rise  or  goes  above  100°  F.  it  is  a wise  thing  to 
insist  on  quietness,  rest,  and  light  diet.  If  it  remains 
above  100°  F.  for  any  considerable  time  it  will  be  well 
to  consult  a doctor. 

To  take  the  temperature  shake  the  mercury  down  at 
least  two  degrees  below  normal  and  have  the  ther- 
mometer clean.  The  temperature  is  most  frequently 
taken  by  mouth.  Place  the  bulb  of  the  thermometer 
under  the  tongue  and  see  that  the  lips  are  firmly  closed 
for  at  least  three  minutes.  Always  warn  a child  or 
a new  patient  to  be  careful  not  to  break  or  bite  the  bulb. 
It  is  never  wise  to  put  a thermometer  in  the  mouths  of 
small  children  or  delirious  patients. 

The  temperature  of  babies  and  small  children  and  also 
of  delirious  or  unconscious  patients  should  be  taken  by 
rectum,  always  using  a separate  thermometer  for  this 
purpose  if  possible.  Oil  the  bulb  and  insert  it  about 
two  inches  after  turning  the  patient  on  one  side.  Always 
remain  constantly  beside  the  patient  while  taking  the 
temperature  in  this  way.  A sudden  lurch  might  easily 
break  the  thermometer  and  leave  the  broken  glass  in 
the  rectum.  The  temperature  may  also  be  taken  in  the 
axilla  and  vagina.  The  axilla  temperature  is  more 
likely  to  be  uncertain,  and  as  a rule  registers  lower  than 
in  the  mouth  or  the  rectum. 

Care  of  the  Thermometer. — Always  wash  the  thermo- 
meter carefully  in  cold  water  after  using  it  before  re- 
placing it  in  the  case.  When  the  patient  has  a com- 
municable disease  the  thermometer  should  be  washed 
in  a disinfectant  after  using.  Otherwise  the  germs  of 
the  disease  may  l)e  carried  to  the  next  patient  who  uses 
it.  In  the  absence  of  other  disinfectants  the  nurse  may 


SYMPTOMS  OF  SICKNESS 


87 


use  a solution  made  by  dissolving  a teaspoonful  of 
baking  soda  in  a glass  of  water. 

Time  of  Taking  Temperature, — There  should  be  regular 
times  for  taking  and  recording  the  temperature  in  any 
prolonged  illness.  It  should  be  taken  morning  and 
evening  at  about  the  same  hour  each  day  in  any  case  of 
continued  fever.  The  doctor  will  usually  give  direc- 
tions as  to  how  many  times  each  day,  besides  morning 
and  evening,  he  wishes  the  temperature  taken.  Every 
four  hours  in  serious  illness  is  a common  rule.  Under 
exceptional  circumstances  for  a day  or  two  he  may 


Fig.  21. — Chart  of  the  temperature  ( ) and  pulse  ( ) in  typhoid 

fever  of  moderate  severity  in  a male  child  five  years  old.  {Kerr.) 


wish  it  taken  every  three  or  even  two  hours,  but  without 
definite  orders  it  is  rarely  wise  or  necessary  to  test  the 
temperature  oftener  than  once  every  four  hours.  Some 
home  nurses  who  have  learned  to  use  clinical  thermo- 
meters, in  their  over-anxiety  have  bothered  the  patient 
by  taking  the  temperature  every  fifteen  or  twenty  min- 
utes, a procedure  wholly  unnecessary  and  undesirable. 

The  Recording  of  the  Temperature  is  Important, — In 
all  cases  the  time  at  which  it  was  taken  should  be  written 
down  when  the  degree  of  temperature  is  recorded.  If 
taken  otherwise  than  by  mouth  the  fact  should  also 
be  stated. 


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The  average  normal  pulse  rate  is  72  beats  to  the  minute 
in  a healthy  adult.  During  a baby’s  first  year  it  is 
likely  to  be  from  105  to  120.  In  childhood  it  varies, 
always  being  more  rapid  than  in  adult  life.  At  the 
age  of  six  a pulse  rate  of  100  has  been  given  as  a normal 
average;  at  eight  to  ten  a pulse  rate  from  80  to  90  may 
be  considered  normal. 

To  find  the  pulse  rate,  place  three  finger  ends  over  the 
artery  where  it  approaches  the  surface  of  the  body  at 
the  outer  side  of  the  wrist,'  and  count  for  a full  minute. 
To  make  sure,  it  is  well  to  count  twice  for  a half  minute 
at  a time  and  see  if  the  counts  agree.  • To  count  the  pulse 
accurately  is  never  an  easy  thing  at  first,  and  intelligent 
observation  regarding  the  character,  strength  and  rate 
of  the  pulse  comes  only  as  a result  of  continued  practice. 
This  method  of  observing  symptoms  may  be  easily 
practiced  on  healthy  people,  noting  the  difference  in  the 
rate  after  running  or  active  exertion,  sitting,  standing, 
or  lying.  The  strength  of  the  pulse  should  also  be 
noted.  The  pulse  rate  in  a child  is  influenced  by  very 
slight  causes,  and  in  an  adult  the  rate  may  vary  very  much 
in  health.  Exercise,  and  excitement  of  any  kind  influ- 
ence the  rate  and  when  fever  is  present  the  pulse  is  more 
rapid. 

Respiration. — By  this  we  mean  the  act  of  breathing, 
the  taking  in  and  giving  out  air  from  the  lungs.  The 
average  rate  of  normal  respiration  per  minute  is  18  in 
adults.  In  infants  it  is  extremely  variable,  it  may  range 
from  44  to  24.  From  4 to  15  years  the  rate  may  range 
from  20  to  25  per  minute.  It  should  be  remembered  that 
the  act  of  breathing  in  and  breathing  out  of  air,  together 
count  one  respiration.  Excitement  or  exertion  will 
increase  the  rate.  To  estimate  the  frequency  of  the 
respiration,  watch  and  count  the  in  and  out  movements 
of  the  chest  or  place  the  hand  lightly  over  the  chest  or 
abdomen  when  the  patient  is  quiet  or  sleeping. 

Temperature,  pulse  and  respiration  are  three  very  im- 
portant synq)toms  which  should  be  considered  together, 


SYMPTOMS  OF  SICKNESS 


89 


•and  taken  and  recorded  at  or  near  the  same  time.  Of 
the  three,  the  pulse  rate  is  the  most  valuable  indication. 
The  temperature  may  be  high,  but  if  the  heart  action, 
as  indicated  by  the  pulse,  remains  strong  and  regular, 
there  is  little  reason  for  great  alarm. 

Points  to  be  Remembered. — Avoid  being  an  alarmist. 
Do  not  imagine  that  every  threatened  illness  must  be 
dignified  by  the  name  of  a serious  disease. 

Fasting  a day  or  two  will  do  more  to  cure  some  con- 
ditions than  drugs. 

Do  not  try  to  force  a child  or  adult  to  eat  when  he  is 
not  hungry. 

In  a great  many  diseases  the  early  symtoms  are  very 
much  the  same. 

Remember  that  children  are  liable  to  have  much  wider 
variations  in  temperature  than  adults.  Trifling  dis- 
orders are  often  sufficient  to  produce  high  fever  in  a 
child. 

Do  not  wash  the  thermometer  in  warm  water.  If 
too  warm  it  is  bad  for  the  thermometer,  and  it  often 
leads  to  undue  alarm  if  it  registers  high  and  is  not 
shaken  down. 

Try  to  be  regular  in  the  time  of  taking  temperatures. 
Do  not  trust  to  your  memory,  but  write  down  at  once 
the  degree  of  temperature  registered.  Remember  that 
there  are  many  conditions  which  cause  the  pulse  rate  to 
vary.  The  pulse  is  a much  more  important  indication 
of  the  patient^s  condition  than  the  temperature. 

Temperature,  pulse  and  respiration  should  be  consid- 
ered together. 


REVIEW  QUESTIONS. 

1.  Mention  some  symptoms  common  to  all  fevers. 

2.  What  is  the  average  normal  temperature  ? 

3.  How  may  the  degree  of  the  body  temperature  be  tested  ? 

4.  What  degree  of  temperature  above  and  below  normal  would 
you  consider  serious  ? 

5.  Mention  some  precautions  which  you  would  use  in  taking  the 
temperature  of  a child  or  a delirious  patient. 


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6.  What  is  the  average  normal  pulse  rate  ? 

7.  How  would  you  count  the  pulse  ? 

8.  In  case  both  arms  and  hands  were  bandaged  how  might  the 
pulse  be  counted  ? 

9.  What  do  you  mean  by  respiration  ? 

10.  What  is  the  average  normal  respiration,  and  how  would  you 
count  it  ? 

11.  Mention  some  conditions  which  influence  both  the  rate  of  pulse 
and  respiration. 

12.  Of  temperature,  pulse  and  respiration  which  is  the  most  im- 
portant ? 


CHAPTER  X. 


SYMPTOMS  OF  SICKNESS  (continued). 

Demonstration  and  Practice  Work, — Counting  pulse  and  respi- 
ration. Keeping  bedside  notes. 

Pain  is  a common  though  not  invariable  symptom  of 
disease.  It  is  one  of  nature^s  signals  of  danger,  to  warn 
us  that  some  part  of  the  body  machinery  is  not  working 
as  it  should. 

The  degree  or  intensity  of  the  pain  is  something  which 
only  the  patient  knows,  and  often  he  fails  to  describe  it 
at  all  accurately.  Many  patients  do  not  bear  pain  well 
and  exaggerate  in  regard  to  their  sufferings.  Others 
make  light  of  pain  when  it  is  quite  serious.  When  a 
child  complains  of  pain,  it  is  wise  to  ask  him  to  put  his 
hand  over  the  part  in  which  the  pain  is.  A child  often 
complains  of  headache  or  other  ailment  because  he  has 
heard  grown  up  people  complain.  The  home  nurse 
should  notice  whether  the  pain  may  be  relieved  or 
increased  by  change  of  position.  Also  whether  it  is  a 
constant  or  spasmodic  pain,  and  if  there  are  external 
symptoms  such  as  redness  or  swelling  of  the  part. 

In  a book  of  this  character  with  limited  space,  only  a 
few  of  the  more  important  indications  of  disease  can  be 
mentioned.  Each  case  will  have  its  own  distinct 
features.  It  is  always  well  to  be  on  the  alert  to  note 
and  mention  to  the  doctor  symptoms  which  seem  a 
deviation  from  the  normal  condition,  even  though  the 
home  nurse  may  not  be  able  to  judge  as  to  their  impor- 
tance. She  should  also  try  to  be  sure  she  is  giving  the 
doctor  facts,  not  her  own  opinion  or  the  patient^s. 

The  position  in  bed  tells  something  to  the  practiced 
eye.  If  the  patient  has  a tendency  to  fall  on  his  back  or 

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lie  on  one  side  constantly,  if  the  limbs  are  drawn  up,  if  he 
has  difficulty  in  breathing  and  asks  to  be  propped  up,  if 
lying  on  his  chest  or  abdomen  seems  to  relieve  pain,  if 
he  is  restless  or  nervous  or  quiet,  because  movement 
causes  pain;  all  these  are  worthy  of  mention  when  the 
doctor  comes. 

Bowels. — The  discharges  from  the  bowels  are  always  im- 
portant to  observe.  Notice  whether  these  are  consti- 
pated, dry  and  hard,  or  soft  and  watery,  whether  there 
is  pain  at  the  time  the  bowels  move  or  after,  whether  the 
movements  are  small  and  frequent,  whether  there  are 
particles  of  undigested  food  or  traces  of  curdled  milk, 
whether  there  is  any  sign  of  blood  or  any  changes  from 
the  ordinary  or  normal  color.  The  regularity  or  fre- 
quency should  always  be  noted. 

Urine. — The  average  healthy  adult  discharges  from 
the  body  each  24  hours  not  less  than  2 1/2  pints  of  urine, 
though  the  amount  in  health  varies.  The  home  nurse 
who  is  in  charge  of  a bed  patient  should  be  able  to  tell 
whether  or  not  there  seems  to  be  too  much  or  too  little 
urine  thrown  off,  and  whether  there  is  anything  unusual 
about  its  appearance.  In  many  cases  it  may  be  neces- 
sary to  save  a specimen  for  the  doctor  to  examine,  and 
also  to  measure  the  amount  passed. 

For  measuring  urine  a wide  mouthed  bottle  can  be 
used.  Paste  a strip  of  paper  on  one  side  from  bottom 
to  top.  With  the  little  measuring  glasses  used  for 
medicine  which  can  be  secured  at  any  drug  store, 
measure  one  ounce  of  water — two  tablespoonfuls — and 
pour  into  the  bottle.  With  a pen  or  indelible  pencil 
draw  a line  on  the  strip  of  paper,  and  pour  in  another 
ounce,  marking  the  point  on  the  paper  reached  when 
the  bottle  is  standing  on  a level  table.  Continue 
pouring  and  marking  carefully,  till  the  paper  has 
recorded  the  number  of  ounces  the  bottle  holds.  Such 
a method  is  easily  followed,  and  is  much  more  reliable 
than  any  guess  work  in  regard  to  quantities. 

To  secure  a specimen  of  urine  be  sure  first  of  all  that 


SYMPTOMS  OF  SICKNESS 


93 


the  vessel  which  is  to  receive  it  is  clean.  Scald  it 
before  giving  it  to  the  patient.  The  first  urine  passed 
in  the  morning  is  often  asked  for.  If  it  is  to  be  sent  to 
the  doctor’s  office  for  examination  put  it  in  a perfectly 
clean  bottle,  cork  it  with  a clean  cork,  and  have  the 
patient’s  name  affixed  to  it. 

The  quantity  of  urine  secreted  in  24.  hours  is  import- 
ant to  know.  To  ascertain  this  start  to  count  from 
some  hour  when  the  bladder  has  been  emptied.  For 
instance,  if  one  wished  to  know  how  much  urine  was 
secreted  by  the  kidneys  from  four  o’clock  one  afternoon 
till  four  o’clock  the  next,  empty  the  bladder  at  four 
o’clock.  Do  not  count  the  quantity  passed  at  that 
time,  for  the  same  reason  that  if  you  wished  to  measure 
the  quantity  of  rain  that  fell  from  a given  point  on  the 
roof,  you  would  place  an  empty  bucket,  not  one  that  was 
partly  full. 

Chills  are  always  an  important  indication  that  some- 
thing is  wrong.  Sometimes  a chill  is  an  indication  that 
pus  is  forming  somewhere  in  the  body.  Sometimes  at 
the  beginning  of  pneumonia  or  scarlet  fever  and  in  the 
course  of  some  forms  of  blood  poisoning  chills  occur. 
There  is  a difference  between  a real  chill  and  a chilly 
feeling.  With  a real  chill  there  is  practically  always  a 
fever,  even  though  the  patient  feels  cold  and  is  shiver- 
ing. A nervous  chill  sometimes  occurs  after  severe  pain 
or  because  of  excessive  nervousness.  The  nervous  chill 
usually  passes  away  quickly  and  is  rarely  serious. 

Puffiness  around  the  eyes  or  on  the  backs  of  the  hands, 
or  in  the  feet  and  ankles  should  never  be  regarded 
lightly.  The  trouble  may  be  temporary  or  not  very 
serious,  but  neglect  to  consult  a doctor  regarding  these 
conditions  very  often  brings  serious  consequences. 
In  most  cases  if  treatment  is  started  in  time  serious 
trouble  is  avoided. 

Danger  Signals  in  Children. — Many  diseases  and 
deformities  may  be  prevented  if  the  home  nurse  is  wise 
enough  to  see  conditions  and  tendencies  before  the 


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trouble  is  far  advanced,  and  consult  a wise  reliable 
physician. 

Mouth  breathing  is  an  important  sign  that  something 
is  wrong.  Either  the  nose  is  stopped  up  by  secretions 
or  there  is  a growth  at  the  back  of  the  nose. 

The  trouble  is  frequently  associated  with  enlarged 
tonsils.  The  child  who  is  a mouth  breather  sleeps 
poorly,  snores  and  usually  has  a running’^  nose;  the 
voice  has  an  abnormal  sound  and  clear  pronunciation  is 
impossible.  Such  conditions  frequently  lead  to  ear- 
ache and  deafness.  The  child  who  is  a mouth  breather 
will  not  get  on  well  at  school,  has  a stupid,  vacant,  awk- 
ward look  and  will  have  a hard  time  later  on,  to  get  or 
keep  a job.  He  is  both  physically  and  mentally  handi- 
capped. The  growth  or  obstruction  to  breathing  is  easily 
and  quickly  removed  and  this  should  be  attended  to  in 
every  case.  Chronic  mouth  breathing  is  not  a habit 
that  children  will  grow  out  of. 

A bad  breath  is  another  danger  signal  that  should  be 
heeded.  It  may  come  from  decaying  or  dirty  teeth, 
from  a disordered  stomach  or  food  tract  or  from  catar- 
rhal trouble,  but  the  cause  in  any  case  should  be 
searched  out  and  removed.  In  a great  many  diseases, 
the  infectious  germ  enters  the  mouth,  and  bad  teeth 
enlarged  tonsils  and  adenoids  harbor  germs  and  render 
the  child  especially  susceptible  to  disease. 

Keeping  the  teeth  in  good  order,  and  giving  the 
mouth  a thorough  housecleaning  twice  a day,  will  do 
much  to  prevent  disease  germs  finding  lodgement  in 
the  body  and  also  keep  the  breath  pure. 

Slight  lameness  or  an  awkward  walk  is  often  supposed 
to  be  due  to  growing  pains  and  neglected.  It  may  be 
the  first  pronounced  symptoms  of  hip  joint  disease. 
The  frequent  desire  to  lean  against  some  support,  the 
high  hip  or  shoulder,  the  inclination  to  stand  with  the 
abdomen  protruding,  or  upon  one  leg,  sudden  starting  or 
crying  during  sleep,  squinting,  fidgeting,  jerking  move- 
ments, twitching  of  the  face,  repeated  attacks  of  gid- 


SYMPTOMS  OF  SICKNESS 


95 


diness,  excessive  nervousness,  lumps,  small  or  large, 
often  found  under  the  jaw,  chronic  discharges  from  the 
eyes  and  ears,  frequent  earache,  and  such  troubles  as 
ringworm,  itch,  eczema,  worms  in  children  are  all  signs 
that  call  for  an  examination  right  away. 


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Keeping  bedside  notes  is  quite  often  a duty  which  the 
home  nurse  is  called  on  to  perform  in  cases  of  serious 
illness.  The  points  which  are  usually  recorded  are 
the  temperature,  pulse,  and  respiration,  sleep,  diet  and 


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medicine  taken  by  the  patient,  the  discharges  from 
the  bowels,  and  of  urine,  and  the  result  of  special 
treatments. 

Each  disease  has  its  own  manifestations  and  changes, 
which  are  placed  in  the  column  for  “remarks.’^ 

Points  which  are  of  special  importance  in  making 
reports  for  the  doctor  are:  the  time  at  which  the  thing 
recorded  really  occurred,  absolute  truthfulness,  and  clear 
definite  statements.  Instead  of  saying  he  took  some 
milk,  say  ^^he  took  a half  tumblerful  of  milk’^  or  what- 
ever amount  he  took.  Instead  of  saying  slept  pretty 
weir’  say  slept  5 or  6 hours.”  If  the  patient  com- 
plains of  pain  try  to  state  the  location  of  pain.  The 
doctor  must  often  be  guided  in  his  treatments  by  the 
reports  made  by  the  home  nurse,  and  suppositions  or 
opinions  are  poor  things  to  use  as  guides  in  serious  cases. 
State  facts  which  you  positively  know.  Never  try  to 
conceal  anything  from  the  doctor.  If  you  have  made  a 
mistake  be  sure  to  tell  the  doctor  about  it. 

Points  to  be  Remembered. — A great  deal  of  the.  dif- 
ference bet  ween  the  trained  and  the  untrained  nurse 
IS  in  theiF ability  to  see  and  to  describe  accurately  their 
observations. 

Try  to  give  the  doctor  facts  rather  than  opinions. 

Neither  exaggerate,  lessen,  color,  nor  suppress  the 
truth  about  a patient’s  condition. 

The  amount  of  urine  passed  is  affected  by  various  con- 
ditions— perspiration,  excitement,  the  amount  of  water 
drunk,  etc. 

The  mouth  breathing  child  is  handicapped,  and  neglect 
to  have  the  trouble  remedied  leads  to  serious  results. 

In  practically  all  cases  of  lameness  and  deformity  a 
child  can  be  relieved  or  helped  if  taken  to  the  right  kind 
of  a doctor  at  the  right  time.  There  are  specialists  in 
this  branch  of  work  in  most  large  cities.  Avoid  the 
advertising  ^^specialists”  or  the  advertising  doctor  of 
any  kind.  The  best  doctors  do  not  advertise  their 
cures  or  methods  through  the  daily  or  weekly  press. 


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Neglect  of  throat  troubles  is  a common  cause  of 
deafness. 

Do  not  neglect  a bad  breath  as  though  it  were  an  unim- 
portant thing.  It  is  practically  always  an  indication 
that  some  part  of  the  body  is  out  of  order. 

In  keeping  bedside  notes  for  the  doctor  study  to  have 
v^them  concise,  full,  accurate  and  neat.  The  doctor  does 
^Cnot  see  much  of  the  nursing,  but  he  sees  the  notes,  and 
mis  opinion  is  materially  influenced  by  them. 

REVIEW  QUESTIONS. 

1.  What  observations  should  the  home  nurse  make  regarding 
pain? 

2.  What  should  be  noted  in  regard  to  position  assumed  in  bed, 
especially  in  cases  of  serious  illness? 

3.  In  preparing  a specimen  of  urine  for  a doctor  to  examine  what 
precautions  should  be  observed? 

4.  How  would  you  know  that  a patient  was  having  a genuine 
chill?  What  would  you  do? 

5.  What  is  a common  cause  of  mouth  breathing  and  what  should 
be  done  to  remedy  it? 

6.  Name  several  causes  for  a bad  breath. 

7.  Mention  some  danger-signals’’  which  are  often  neglected. 

8.  What  are  the  chief  characteristics  of  a well-kept  bedside 
record? 

9.  What  symptoms  would  lead  you  to  suppose  that  a child  had 
fever? 

10.  Prepare  a report  for  12  hours  of  a severe  case  of  grippe  of  which 
you  had  charge. 


? 


CHAPTER  XI. 


BATHS  AND  PACKS. 

Demonstration  and  Practice  Work. — How  to  give  a sponge  bath 
to  reduce  fever.  Administration  of  foot-bath,  pack,  Scotch 
douche  to  a joint. 

It  is  well  for  the  home  nurse  to  remember  that  water 
is  the  most  valuable  and  most  easily  obtained  remedy 
that  she  has  at  her  disposal.  It  can  be  used  in  a greater 
variety  of  ways  than  any  other  single  remedy. 

The  Uses  of  Water. — Some  of  the  uses  of  water  in  the 
sick  room  are: 

To  check  local  inflammation. 

To  reduce  fever. 

To  slow  the  pulse  and  relieve  restlessness. 

To  relieve  pain. 

To  check  hemorrhage. 

To  help  throw  off  waste  matter. 

As  a stimulant. 

In  a previous  chapter,  directions  were  given  for  giving 
a simple  cleansing  bath  to  a patient  in  bed. 

The  cold  sponge  bath  is  one  of  the  methods  used  most 
frequently  to  reduce  fever.  When  properly  given  it  is 
one  of  the  most  useful  forms  of  treatment,  especially  when 
the  skin  is  hot  and  dry,  but  unless  care  is  used,  such  a bath 
may  leave  the  patient  with  a temperature  higher  than  it 
was  before  giving  it. 

Before  giving  the  bath,  the  temperature,  pulse  and 
respiration  should  be  taken.  Take  off  the  gown  and  put 
the  patient  between  thin  old  blankets  as  for  a sponge  bath. 
Protect  the  pillow  with  a towel.  Wring  a towel  out  of 
ice  water  and  put  it  on  the  head,  or  use  an  ice  cap  if  one 
is  obtainable.  Change  or  re-wet  the  towel  as  it  becomes 

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warm.  If  the  feet  are  cold,  apply  a hot  water  bag  or 
artificial  heat  of  some  kind.  Have  a large  basin  of  water 
ready,  and  a large  sea  sponge  or  soft  wash  cloth.  The 
doctor  will  give  direction  as  to  the  temperature  of  the 
water.  The  cooling  effect  is  produced  to  a large  extent 
by  evaporation  and  does  not  depend  entirely  on  the  cold- 
ness of  the  water.  It  is  well  to  start  with  the  water 
about  60°  to  65°  F.  When  possible,  have  a piece  of  ice 
ready  to  put  in  as  the  sponging  proceeds.  Do  not  have 
the  sponge  wet  enough  for  the  water  to  drip. 

Begin  by  sponging  the  face  and  neck.  Keeping  the 
parts  covered,  sponge  the  arms  and  body  lightly  and 
slowly  till  the  parts  feel  cold  to  the  back  of  the  hand. 
Do  not  use  a towel,  but  let  the  skin  absorb  as  much  water 
as  possible,  and  let  the  drying  take  place  by  evaporation. 
Next  sponge  the  arms  all  over,  using  light  downward 
strokes.  On  the  inner  surface  of  the  arms  the  large  blood- 
vessels come  nearer  the  surface  than  on  the  outer  side, 
and  more  time  should  be  given  to  these  parts.  Next, 
bare  the  chest  and  abdomen  down  to  the  hips,  and  with 
long  light  strokes,  cooling  the  sponge  with  every  third  or 
fourth  stroke.  If  the  fever  is  very  high  and  persistent 
it  is  a good  plan  to  wring  a towel  out  of  cold  water  and 
apply  it  to  the  chest  and  abdomen  while  the  sponging 
is  going  on.  Sponge  the  legs  next.  Take  one  leg  at  a 
time,  keeping  the  other  covered.  Bend  it  at  the  knee, 
and  sponge,  taking  about  five  minutes  to  each  leg.  Turn 
the  patient  over  on  one  side,  and  sponge  the  back. 

The  cold  sponge  bath  should  take  at  least  half  an  hour. 
Leave  the  patient  lightly  covered  for  about  fifteen 
minutes  for  the  drying  to  take  place.  Then  put  on  the 
gown  and  make  the  patient  comfortable.  Such  a bath 
when  properly  given  should  be  a help  in  quieting  nervous 
symptoms  as  well  as  reducing  the  fever. 

Foot-baths. — A foot-bath  may  be  given  to  a patient 
in  bed  without  danger  of  wetting  the  mattress,  by  turn- 
ing the  patient  across  the  bed  and  letting  the  feet  rest 
on  a chair.  Have  a bucket  or  foot-tub  with  water  as 


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hot  as  can  be  borne  and  sufficient  to  reach  the  knees. 
Have  hot  water  ready  to  add  to  keep  the  water  at  a 
desired  temperature. 

Cover  the  chest  and  legs  down  to  the  knees.  Have 
an  old  blanket  or  cotton  quilt  to  wrap  around  the  knees 
and  enclose  the  tub.  If  mustard  is  to  be  added  use  about 
a tablespoonful  to  an  ordinary  bucket  of  water,  rubbing 
the  mustard  to  a paste  in  cold  water  before  adding  it  to 
the  bath-w^ater.  The  foot-bath  should  be  followed  by 
brisk  rubbing  of  the  extremities.  The  limbs  should  be 
warmly  wrapped  and  artificial  heat  applied. 


Fig.  23. — Application  of  the  cold  pack : pressing  the  sheet  between  the  patient’s 
arm  and  body.  {Stoney.) 


Foot-bath  Out  of  Bed, — Place  the  patient  in  a low  chair. 
Have  a quilt  or  thick  blanket  ready  to  wrap  around  chair, 
patient  and  foot-tub,  securing  it  safely  with  pins.  Other- 
wise proceed  as  directed  above. 

Cold  packs  are  given  for  reasons  similar  to  the  cold 
sponge  bath.  When  possible  protect  the  bed  with  a 
rubber  sheet.  If  one  is  not  available  use  a cotton  quilt 
folded.  Have  two  sheets  ready.  Fold  them  lengthwise. 
Wring  them  out  in  cold  water.  Lay  one  under  the 
patient,  the  other  over,  taking  care  that  it  is  in  contact 


BATHS  AND  PACKS 


101 


with  the  surface  skin,  over  every  part  it  is  supposed  to 
cover.  Wrap  the  arms  in  towels  wrung  out  of  water. 
Apply  a cold  wet  compress  to  the  head  and  heat  to  the 
feet.  From  twenty  to  forty  minutes  is  the  average 
length  of  time  for  these  packs. 

Hot  Packs, — When  hot  or  tepid  packs  are  to  be  given 
proceed  in  the  same  way,  using  hot  water.  Use  an  old 
blanket  for  the  upper  covering.  It  is  desirable  to  have 
the  water  the  sheets  are  wrung  out  in,  several  degrees 


hotter  than  it  is  to  be  applied  as  it  cools  rapidly.  Cover 
the  pack  with  heavy  blankets  or  quilts  and  use  hot 
bottles  around  it  if  the  pack  is  to  be  given  to  induce  per- 
spiration. Hot  or  tepid  packs  are  often  given  to  quiet  a 
nervous  or  restless  patient  and  produce  sleep,  as  well  as 
to  induce  perspiration. 

Spray  baths  are  usually  given  for  tonic  purposes.  They 
may  be  taken  while  sitting  or  standing  in  a tub,  the  head 
being  protected  from  the  spray.  They  are  usually  fol- 
lowed by  a brisk  rub  with  a coarse  bath  towel. 

The  Scotch  douche  is  a form  of  treatment  which  can  be 
given  at  home  without  special  apparatus  and  has  been 
used  with  much  success  in  cases  of  chronic  backache, 
relaxed  or  paralyzed  muscles,  and  certain  joint  troubles. 
It  consists  in  alternate  application  of  hot  and  cold  water 
to  a part.  When  applied  to  the  spine,  the  part  is  first 


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sponged  with  water  as  hot  as  can  be  borne,  and  alternat- 
ing it  with  rubbing  with  a piece  of  ice.  When  the  treat- 
ment is  to  be  applied  to  the  knees  or  ankle  pass  a turn  of  a 
roller  bandage  around  the  part  to  conduct  the  drip  into 
a basin  below.  Have  at  hand  hot  water  and  ice  water, 
and  pour  slowly,  alternating  about  every  minute. 

The  salt  rub  consists  in  applying  salt  of  medium 
fineness,  and  slightly  moistened,  to  the  surface  of  the 
body.  The  amount  of  pressure  needs  to  be  regulated 
according  to  the  sensations  of  the  patient.  Care  must  be 
used  that  the  skin  is  not  permanently  irritated.  The 
patient  may  sit,  stand  or  lie  down  during  the  treatment. 
The  salt  rub  is  followed  by  a spray  bath  and  a brisk 
rubbing  with  a coarse  towel.  It  is  useful  in  mild  forms 
of  nervous  exhaustion,  in  cases  of  general  debility,  and 
as  a tonic  measure  for  people  who  are  tired  in  body  and 
mind. 

Points  to  be  Remembered. — Water  is  the  most  valuable 
of  all  home  remedies.  It  can  be  used  for  a greater  variety 
of  conditions  than  any  other  remedy. 

Every  home  nurse  should  study  the  methods  of  using 
simple  natural  remedies  such  as  water,  including  ice  and 
steam,  heat,  rest,  light,  etc.,  and  use  them  in  preference 
to  drugs  in  a great  many  conditions. 

The  method  of  giving  a sponge  bath  to  reduce  fever 
will  greatly  influence  the  result. 

Never  try  to  hurry  through  a fever  bath.  Plenty  of 
time  must  be  taken  if  it  is  to  do  any  good. 

Always  endeavor  to  avoid  unnecessary  exposure  in 
giving  all  treatments. 

Follow  a foot-bath  with  a brisk  rubbing  of  the  feet  and 
legs  and  be  careful  to  avoid  chilling. 

A tepid  pack  is  one  of  the  best  remedies  for  excessive 
nervousness  and  sleepiness. 

Alternate  applications  of  hot  and  cold  water  are  help- 
ful in  a variety  of  conditions. 

A great  many  of  the  l^enefits  which  are  received  at 
liealth  resorts  might  be  secured  at  home  by  the  systematic 


BATHS  AND  PACKS 


103 


use  of  water,  internally  and  externally,  salt  rubs,  rest, 
fresh  air,  regular  breathing  exercises  and  freedom  from 
worry. 


REVIEW  QUESTIONS. 

1.  Mention  some  of  the  uses  of  water  as  a remedy. 

2.  How  should  a cold  sponge  bath  be  given  ? 

3.  Describe  a method  of  giving  a foot-bath  to  a patient  in  bed. 

4.  What  measures  should  be  used  in  giving  a foot-bath  to  a 
patient  out  of  bed  ? 

5.  How  would  you  give  a cold  pack  ? 

6.  For  what  purposes  are  cold  packs  useful? 

7.  What  precautions  would  you  take  in  giving  a hot  pack  ? 

8.  How  would  you  give  a Scotch  douche  to  a knee  joint? 

9.  Mention  some  treatments  which  may  be  taken  at  home  when 
a general  tonic  is  needed. 

10.  Describe  the  method  of  giving  a salt  rub. 


CHAPTER  XII. 


HOME  TREATMENTS  AND  HOW  TO  GIVE  THEM. 

Demonstration  and  Practice  Work. — How  to  prepare  and*  give  a 
soapsuds  enema.  Preparation  and  application  of  mustard  plaster; 
ice  compress.  How  to  fill  an  ice  cap  properly  and  apply  it. 

In  almost  all  cases  of  illness  when  the  patient  is  con- 
fined to  bed  it  becomes  necessary  to  assist  nature  to  effect 
a movement  of  the  bowels.  This  is  usually  done  by  the 
use  of  laxative  medicines,  but  there  are  many  cases  where 
it  is  unwise  to  give  medicine  for  this  purpose  or  to  wait 
for  it  to  act  and  an  injection  into  the  lower  bowels 
is  required.  This  is  called  an  enema. 

In  many  cases  also  it  is  necessary  to  give  injections 
into  the  rectum  for  other  purposes. 

The  purposes  for  which  rectal  injections  are  commonly 
given  are:  To  move  the  bowels;  to  help  to  expel  worms; 

to  relieve  pain;  to  check  diarrhea;  to  stimulate,  in  case 
of  shock  or  much  loss  of  blood;  to  nourish  the  patient. 

In  all  such  treatments  there  are  a variety  of  details 
to  be  observed  which  will  greatly  influence  the  result. 
For  instance,  in  some  cases  it  is  desired  for  the  fluid  to 
remain  in  the  bowels  and  be  absorbed  into  the  system. 
In  such  cases  it  is  necessary  to  be  careful  not  to  give 
too  much  and  the  fluid  should  be  only  lukewarm. 
In  other  cases  it  is  desired  to  have  the  fluid  expelled 
promptly  and  the  bowels  flushed  out.  In  these  cases 
more  fluid  is  given  and  it  is  given  warmer. 

Purgative  Enema. — To  give  a purgative  enema  a 
fountain  syringe  is  preferable  to  the  bulb  syringe  found 
in  so  many  homes.  Soap  suds  made  with  castile  or 
ivory  soap  is  commonly  used  for  this  purpose.  Occasion- 
ally glycerin  or  some  other  drug  is  added.  Make  a good 

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frothy  soap  suds  and  have  it  as  hot  as  the  patient 
can  take  it  comfortably.  Never  use  the  common  brown 
or  laundry  soap  for  this  purpose.  For  an  adult  from 
two  to  four  pints  will  be  needed,  and  for  a child  from  one 
to  two  pints. 

Place  the  patient  on  the  left  side  with  the  knees  bent. 
It  is  a good  plan  to  protect  the  bed  by  slipping  a thick 
newspaper  under  the  hips.  The  bed-pan  or  commode 
should  be  at  hand,  ready  before  the  injection  starts. 

The  fountain  syringe  or  enema  can  is  arranged  with  a 
rubber  rectal  tip  or  nozzle  attached.  Sometimes  a 
rectal  tube  which  will  carry  the  fluid  high  up  into  the 
bowel  is  necessary  for  the  best  results. 

Oil  the  rubber  tip  and  let  the  fluid  run  through  the 
tube  till  the  air  is  expelled  and  the  fluid  runs  warm. 
Pinch  the  tube  just  above  the  rubber  nozzle  and  slowly 
insert  the  nozzle,  directing  the  point  backward  and 
toward  the  left  for  about  three  inches.  Do  not  hold 
the  can  high  unless  so  ordered  by  the  doctor,  and  never 
hurry  about  such  a treatment. 

Soon  after  the  fluid  begins  to  enter  the  bowel  there  is 
a slight  spasm  of  the  rectum  and  the  patient  will  feel 
he  must  expel  it.  This  passes  away  in  a few  seconds, 
and  it  is  always  better  to  wait  until  it  does  before  pro- 
ceeding. As  a rule  it  is  best  to  give  as  much  fluid  as  the 
patient  can  take.  Encourage  him  to  retain  it  as  long 
as  possible.  In  occasional  cases  the  water  is  not  ex- 
pelled, but  this  need  cause  no  special  alarm.  In  about 
an  hour  repeat  it  when  a free  movement  of  the  bowels 
will  be  the  result. 

The  salt  solution  enema  is  one  that  has  been  much 
used  in  recent  years  and  has  helped  to  save  many  lives. 
It  has  been  found  that  salt  solution  resembles  closely 
the  composition  of  the  human  blood  and  mixes  well 
with  it.  It  is  frequently  given  for  stimulation  and 
to  increase  the  volume  of  the  blood  after  serious  hemor- 
rhage, or  in  cases  of  marked  exhaustion. 

To  make  normal  salt  solution  dissolve  one  teaspoon- 


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ful  of  table  salt  In  a pint  of  water.  This  solution  is 
also  much  used  in  the  dressing  of  wounds  and  has  a 
cleansing,  healing  effect  on  body  tissues. 

To  give  an  enema  of  salt  solution  which  is  to  be  re- 
tained, place  the  patient  on  the  back  and  proceed  as 
previously  directed.  The  rectal  tube  will  be  necessary. 
It  should  be  slowly  inserted  (after  being  boiled)  for 
about  14  inches.  The  doctor  will  usually  order  the 
amount  he  wishes  given.  As  a rule  when  an  enema  is 
to  be  retained  it  is  better  not  to  give  more  than  a pint 


at  a time.  If  too  much  is  given  it  is  likely  to  be  expelled 
and  the  patient  will  not  get  the  benefit  of  it.  When 
given  the  patient  for  stimulation  the  salt  solution  enema 
is  given  warmer  than  for  other  purposes  as  the  heat 
adds  to  the  stimulating  effect. 

Rectal  feeding  has  sometimes  to  be  resorted  to  in 
cases  of  persistent  vomiting,  and  for  a variety  of  other 
conditions  when  the  patient  is  unable  to  take  food  by 
mouth.  Such  cases  are  always  serious  and  life  may 
depend  on  the  patient  being  able  to  retain  the  food 
given  him  by  rectum. 

A patient  who  is  being  fed  by  rectum  should  always 
be  given  a purgative  enema  daily.  Once  in  four  or  six 
hours  is  as  often  as  these  nourishing  injections  should 
be  given.  The  doctor  will  always  show  how  to  prepare 
the  fluid  to  be  injected  if  asked  and  if  the  home  nurse 


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is  not  certain  how  to  proceed.  Milk  which  has  been 
predigested,  egg,  and  sometimes  beef  juice  are  substances 
commonly  used.  Four  ounces  or  about  eight  table- 
spoonfuls are  as  much  as  are  likely  to  be  retained. 
The  food  is  given  lukewarm,  very  slowly,  and  the  tube 
withdrawn  very  slowly.  The  patient  may  be  either  on 
the  left  side  or  the  back.  If  on  the  left  side,  place  a 
pillow  under  the  hips  before  giving,  and  let  it  remain 
there  until  danger  of  the  fluid  being  expelled  is  past. 

To  Check  Vomiting. — When  the  patient  is  seized 
with  persistent  vomiting  the  following  measures  may 
be  tried : 

Stop  all  food. 

Keep  the  head  low. 

Allow  no  talking  or  excitement,  but  keep  him  quiet. 

Keep  the  patient  on  the  back  with  a pillow  under  his 
knees. 

Try  giving  bits  of  ice,  to  be  swallowed  whole  before 
being  dissolved. 

If  ice  is  not  at  hand  try  small  sips  of  hot  water  or 
clear  hot  tea. 

Apply  a mustard  plaster  over  the  stomach. 

To  make  a mustard  plaster  mix  one  teaspoonful  of 
mustard  to  three  of  flour.  Use  only  half  the  quantity 
of  mustard  for  a child.  Blend  to  a thick,  smooth  paste 
with  lukewarm,  not  hot,  water.  Spread  it  on  a thin  cloth, 
leaving  an  inch  margin  at  the  edge,  which  is  turned  back 
over  the  paste  to  prevent  its  escaping  and  smearing  the 
clothing.  When  the  patient  is  a child  or  an  aged  person 
it  is  wise  to  add  the  white  of  an  egg  to  the  paste  or  a 
little  oil  or  vaseline.  Apply  and  leave  the  plaster  on 
till  the  skin  is  well  reddened — usually  about  20  to  30 
minutes.  After  removal,  smear  the  part  with  vaselin, 
olive  oil,  or  cold  cream. 

Cold  compresses  are  much  used  as  a method  of  check- 
ing inflammation,  especially  where  the  eye  is  concerned. 
Small  compresses  are  made  of  several  layers  of  soft  clean 
old  linen  or  gauze  cut  about  two  inches  square.  A piece 


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of  ice  is  placed  in  a basin  and  the  little  eyepads  wrung 
out  of  water  are  placed  on  the  ice,  and  renewed  at  least 
every  five  minutes.  If  the  inflammation  is  very  severe, 
they  may  need  to  be  changed  every  two  or  three  minutes, 
as  they  quickly  absorb  the  heat  from  the  part.  If  there 
is  any  discharge  from  the  eye,  the  home  nurse  should  be 
extremely  careful  not  to  carry  the  infection  to  her  own 
eye  when  giving  this  treatment.  The  soiled  compresses 
should  be  put  in  a paper  sack,  when  removed,  and  burned. 
Never  use  a compress  a second  time  if  there  is  a discharge 
from  the  eye.  The  hands  should  be  as  clean  as  it  is 
possible  to  have  them  before  handling  these  compresses. 


Fig.  26. — '‘Perfection”  ice  bag. 


Ice  poultices  are  as  a rule  used  only  when  an  ice  cap  is 
not  available.  To  make  an  ice  poultice  secure  first  a 
piece  of  table  oilcloth  twice  the  size  of  the  area  to  be 
covered.  If  it  is  to  be  used  on  the  chest  or  abdomen,  a 
piece  of  oilcloth  that  when  doubled  will  be  about  nine 
by  twelve  inches  should  be  prepared.  With  the  glazed 
side  inside  fold  the  two  sides  in  toward  the  middle,  letting 
the  edges  overlap  about  an  inch  and  stitch  firmly  twice 
with  the  sewing  machine,  using  a short  stitch.  This 
makes  a firm  bag.  The  ice  is  broken  in  pieces  about  the 
size  of  a small  egg,  mixed  with  bran  or  sawdust,  and  put 
into  the  bag.  A piece  of  soft  cotton  or  gauze  or  a soft 
old  towel  may  be  pinned  around  it.  Pass  a bandage  or 
roller  towel  lightly  around  the  bag  and  abdomen  to  keep 
it  in  place,  and  yet  allow  some  freedom  of  motion  to  the 
patient. 


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Ice  Caps. — In  filling  rubber  ice  caps,  lay  the  cap  on  a 
flat  surface  and  put  the  pieces  of  ice  in  gently.  The 
sharp  corners  of  ice  will  quickly  puncture  a tiny  hole  in 
the  rubber  cap  which  will  cause  leakage.  Be  sure  not  to 
bottle  up  any  more  air  in  the  ice  bag  than  can  be  helped. 
If  there  are  two  ice  caps  in  use,  be  sure  that  the  screw  caps 
are  not  interchanged  or  there  will  probably  be  leakage 
around  the  cap.  Always  fold  a towel  or  piece  of  clean 
cotton  around  an  ice  cap,  but  use  no  pins  if  you  would 
avoid  punctures. 

When  ordered  to  keep  an  ice  cap  on  a patient  be  sure 
to  see  that  the  ice  is  replenished  as  soon  as  needed. 
Otherwise  the  cap  had  better  be  removed. 

To  Give  a Sweat. — The  hot  pack  when  properly  given 
is  one  of  the  best  means  of  giving  a sweat.  These  packs 
are  often  used  when  the  kidneys  for  any  reason  are  not 
doing  their  work  properly,  to  help  the  system  to  throw  off 
waste  matter  through  the  skin.  The  method  of  giving 
the  hot  pack  was  described  in  a previous  chapter.  When 
the  object  is  to  produce  free  perspiration,  several  hot 
bricks  will  be  needed.  Place  on  the  hot  pack  covering 
the  patient,  four  hot  bricks  at  each  side,  and  one  at  the 
feet.  Do  not  let  the  bricks  touch  the  body  or  rest  against 
it  in  any  place.  Pour  on  each  brick  a teaspoonful  of 
alcohol  and  double  the  side  of  the  blanket  or  pack  over  it. 
Cover  quickly  with  a heavy  dry  blanket  or  quilt  so  that 
no  air  can  get  under  the  covers.  Watch  that  the  bricks 
are  not  close  enough  to  the  patient  to  burn.  Keep  the 
blankets  tucked  in  snugly  at  the  neck  and  feet.  Give 
plenty  of  hot  lemonade  to  drink,  or  hot  drinks  of  any 
kind,  but  do  not  allow  the  arms  to  come  out  of  the  covers 
at  any  time  while  drinking.  Always  keep  a cold  com- 
press on  the  head  during  the  treatment. 

To ' avoid  chilling  after  the  pack,  wrap  the  patient 
in  a warm  dry  blanket  for  an  hour,  and  keep  heat  to  the 
feet.  To  secure  a good  sweat  with  ordinary  home  appli- 
ances is  not  as  easy  as  many  suppose,  and  the  home  nurse 
needs  to  watch  every  detail  if  she  is  to  succeed.  She 


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must  be  quick  in  movements  and  watchful  to  see  that 
cold  air  is  not  allowed  to  enter  at  any  place  to  undo  what 
she  is  trying  to  do. 

A hot  air  bath  may  be  used  when  the  patient  is  not 
confined  to  bed  by  placing  the  patient  without  clothing 
in  a cane  seated  chair,  and  with  the  feet  on  a hot  brick. 
Wrap  a heavy  blanket  around  the  chair,  pinning  it  se- 
curely at  the  neck  and  over  this  pin  a heavy  quilt  or 
comforter.  Place  a small  low  lamp — an  alcohol  lamp  is 
the  best — under  the  chair,  and  pin  the  outer  coverings  se- 
curely to  prevent  the  cold  air  getting  under.  Give  the 
patient  plenty  of  hot  drinks  and  keep  him  warm  after- 
ward. 

A hot  air  bath  for  a patient  in  bed  requires  a body 
cradle  of  some  kind.  These  body  cradles  are  frames 
used  to  support  the  bed  clothing.  Such  a cradle  can  be 
made  at  home  by  using  parts  of  three  barrel  hoops — 
securing  the  ends  to  a strip  of  straight  wood.  The 
patient  with  the  clothing  removed,  is  placed  on  a blanket 
with  heat  to  the  feet  and  around  the  sides.  Over  tlie 
cradle  another  blanket  and  a thick  comforter  is  placed. 
At  the  foot  of  the  bed,  a coal  oil  or  gas  stove  is  arranged 
with  a stove  pipe  or  elbow  to  conduct  the  hot  air  under 
the  covers.  Keep  a wet  cold  compress  or  an  ice  cap  to 
the  head,  and  be  careful  to  avoid  chilling  afterward. 
This  treatment  is  continued  from  a half  hour  to  an  hour. 

Points  To  Be  Remembered. — In  giving  all  treatments 
be  sure  to  study  the  details  of  the  instruction  and  care- 
fully observe  them. 

Ask  the  doctor  about  any  point  regarding  which  you 
are  in  doubt. 

In  giving  an  enema  the  amount  of  fluid,  the  tempera- 
ture, and  the  force  of  the  flow  will  all  influence  the 
result. 

If  a patient  vomits,  let  his  stomach  rest. 

There  is  a right  and  a wrong  way,  a neat  and  a slovenly 
way  to  make,  a mustard  plaster.  Try  to  manage  it 
the  right  way. 


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Never  use  a compress  or  dressing  the  second  time 
if  it  is  soiled  with  discharge. 

In  filling  an  ice  cap  be  careful  to  avoid  puncturing 
the  bag  with  the  sharp  corners  of  the  ice. 

Remember  that  when  giving  a sweat  the  results 
desired  may  be  easily  undone  by  being  careless  about 
details. 

Be  sure  that  cold  air  is  not  allowed  to  come  in  contact 
with  the  body  during  a sweat,  and  be  careful  to  avoid 
chilling  afterward. 

REVIEW  QUESTIONS. 

1.  For  what  purposes  are  rectal  injections  given? 

2.  State  the  difference  in  the  methods  used  in  giving  a rectal  in- 
jection which  is  to  be  retained,  and  one  that  is  to  flush  out  or 
cleanse  the  bowel. 

3.  How  should  a purgative  enema  be  given  ? 

4.  Mention  some  of  the  values  of  a salt  solution  injection. 

5.  Describe  some  methods  that  have  proven  useful  in  checking 
vomiting. 

6.  How  should  a mustard  plaster  be  made  ? What  precautions 
should  be  observed  in  its  use  ? 

7.  How  would  you  apply  a cold  compress  to  the  eye  ? How  often 
should  these  be  renewed  ? 

8.  What  precautions  should  be  taken  in  filling  and  applying  an 
ice  cap? 

9.  Describe  one  method  which  may  be  used  to  produce  sweating. 

10.  Mention  some  general  precautions  which  should  be  used  in 

giving  treatments  to  induce  perspiration. 


CHAPTER  XIII. 


HOME  TREATMENTS  AND  HOW  TO  GIVE 
THEM  (continued). 

Demonstration  and  Practice  Work. — Making  and  application  of  a 
linseed  poultice.  A bran  poultice.  A turpentine  stupe.  How 
to  arrange  for  an  eye-bath. 

Poultices  are  much  less  used  now  than  in  former  years. 
They  were  used  formerly  chiefly  as  a means  of  applying 
heat  and  moisture  to  a part.  They  have  the  effect 
of  softening  the  tissues,  dilating  the  superficial  blood 
vessels,  and  relieving  pain.  But  poultices  as  ordinarily 
made  have  many  disadvantages  and  have  been  largely 
supplanted  by  hot  fomentations.  When  properly 
made  and  applied  they  may  serve  a useful  purpose. 

Flaxseed  or  Linseed  Poultices, — To  make  a linseed 
poultice  have  a saucepan  two-thirds  full  of  boiling  water 
on  the  fire,  and  stir  the  meal  into  it  gradually  till  it  is 
thick  enough  to  cut  with  a knife.  It  should  then  be 
beaten  free  from  lumps,  and  spread  evenly,  while  hot,  on 
a poultice  cloth,  leaving  an  inch  margin  all  around  the 
edge  which  is  turned  back  over  the  mass.  This  makes 
what  is  called  an  ^^open  poultice  and  allows  the  linseed 
to  come  in  direct  contact  with  the  skin. 

The  closed  poultice  requires  a cloth  twice  the  desired 
size  of  the  poultice.  The  linseed  mass  is  spread  on  half 
of  it,  leaving  the  margin  as  directed.  A little  oil  of  some 
kind  will  make  it  easier  to  remove  from  the  cloth.  When 
applied,  the  poultice  should  be  covered  with  a thick 
layer  of  cotton  batting.  A piece  of  oilcloth  or  thick 
paper  is  laid  over  the  cotton  to  keep  the  heat  from  escap- 
ing. A bandage  should  be  applied  to  secure  it  in  place. 
Once  poulticing  is  started  provision  should  be  made  to 
continue  it  regularly.  Every  two  or  at  the  most  three 

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hours  (depending  on  the  thickness)  the  poultice  should 
be  renewed.  A cold  poultice  does  more  harm  than  good. 
Before  removing  the  old  cool  poultice,  the  fresh  hot 
one  should  be  on  hand  ready  to  apply.  Never  allow  the 
patient  to  remove  the  cold  poultice  till  you  are  ready 
with  the  fresh  hot  one.  Try  to  keep  in  mind  the  follow- 
ing points  about  poulticing: 

1.  Be  sure  not  to  have  the  poultice  mass  too  thin 
in  consistency. 

2.  When  made,  carry  to  the  bedside  in  a basin,  which 
is  also  used  to  carry  away  the  old  one. 

3.  Remember  that  a cold  poultice  does  more  harm 
than  good. 

4.  Never  take  off  a cold  pcgaltice  till  you  have  the  hot 
one  at  the  bedside  ready  to  put  on. 

5.  Cover  every  poultice  with  a thick  pad  either  of 
cotton  batting  or  flannel,  and  heavy  paper,  and  secure 
it  in  place  with  a bandage. 

6.  Apply  the  poultice  as  hot  as  a patient  can  bear  it, 
but  not  hot  enough  to  burn.  Let  it  come  in  contact 
with  the  skin  very  gradually,  a few  inches  at  a time, 
and  it  is  less  apt  to  cause  discomfort. 

7.  Test  the  heat  of  the  poultice  by  holding  it  to  your 
cheek  before  putting  it  on.  A hot  water  bag  may  be 
laid  over  the  poultice  to  help  to  retain  the  heat. 

8.  Smear  the  skin  with  vaselin  before  applying  the 
poultice. 

9.  A thin  poultice  will  need  to  be  renewed  much 
more  frequently  than  a thick  one. 

10.  If  there  is  no  discharge  from  the  part  to  be  poul- 
ticed, the  cold  poultice  may  be  cut  into  pieces  and 
reboiled  once  or  twice,  adding  a little  fresh  meal  each 
time.  If  used  too  often  it  will  become  sour. 

Bread  poultices  are  easily  and  quickly  made  by  pouring 
boiling  water  over  bread  without  crust.  The  water  is 
then  drained  off  and  the  softened  bread  spread  on  a 
cloth  and  applied  as  previously  directed.  This  poultice 
is  used  chiefly  because  it  is  convenient  to  get,  and  affords 
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temporary  relief  from  pain  in  case  of  slight  inflammation 
from  bruises  or  other  causes.  Bread  poultices  cool 
very  quickly  and  soon  become  hard  and  dry.  They 
should  be  renewed  about  every  half  hour  to  be  of  an}^ 
real  benefit.  Milk  should  never  be  used  to  make  such 
poultices. 

Starch  'poultices  are  occasionally  used.  They  are 
made  with  laundry  starch  and  in  the  same  way  as  for 
laundry  purposes.  They  should  be  made  quite  thick 
and  applied  as  hot  as  possible.  A starch  poultice  applied 
overnight  and  renewed  at  intervals  during  the  day,  is  an 
excellent  method  of  softening  the  crusts  that  form  as 
a result  of  eczema.  If  applied  to  a child's  head  for  this 
purpose,  the  hair  should  first  be  cut  short. 

Bra'll  poultices  are  sometimes  used  instead  of  linseed 
meal  and  for  the  same  purpose.  To  make  the  bran 
poultice,  take  a piece  of  flannel  twice  the  size  of  the 
desired  poultice.  Spread  a thick  layer  of  bran  over 
half  of  it.  Turn  the  other  half  over  it;  turn  the  edges 
in  and  stitch  around  the  edges  and  through  several  times 
to  keep  the  bran  in  place.  Wring  this  out  of  hot  water. 
Apply  as  with  a linseed  poultice,  cover,  and  secure  in 
place  with  a bandage.  Two  of  these  poultices  should 
be  made  so  that  they  can  be  alternated,  and  no  time 
elapse  while  the  poultice  is  being  prepared. 

Hop  poultices  are  made  in  much  the  same  way  as  bran. 
The  dry  hops  are  sewn  into  a thin  bag,  which  is  dipped 
in  hot  water  and  applied.  This  poultice,  applied  to 
the  back  of  the  neck  is  an  old-fashioned  remedy  in  case 
of  sleeplessness. 

Hot  fomentations  or  stupes  constitute  a most  valu- 
able remedy  which  is  available  in  any  home.  A piece 
of  flannel,  some  boiling  water  and  a stupe  wringer  are 
necessary.  Tlie  backs  of  old  flannel  undervests  or  a 
a piece  of  old  blanket  folded  till  it  is  four  thicknesses 
answer  very  well  for  stupe  cloths. 

A fomentation  or  stupe  that  is  cool  enough  to  he  wrung 
out  with  the  hands  is  too  cool  to  do  any  good. 


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A stupe  wringer  is  made  by  taking  a piece  of  heavy 
towelling  or  ticking,  putting  a wide  hem  in  it  on  each 
end  through  which  a stick  is  passed.  A piece  of  broom 
handle  20  to  24  inches  long  is  often  used.  The  flannel 
is  put  in  a pan  of  water  on  the  stove  and  allowed  to  boil. 
It  is  then  picked  out  and  dropped  in  the  stupe  wringer. 
The  sticks  are  twisted  in  opposite  directions  to  wring  it 
as  dry  as  possible.  It  is  then  shaken  and  placed  over 
the  part  complained  of,  letting  it  down  by  degrees,  and 
withdrawing  the  hands  from  under  it  very  gradually. 

Stupes  or  fomentations  need  to  be  covered  with  a 
thick  pad  of  cotton  batting  over  which  a piece  of  oilcloth 
or  several  thicknesses  of  paper  are  laid,  and  a bandage 
should  be  passed  around  the  part  to  keep  it  in  place. 

The  nurse  who  is  expected  to  keep  hot  fomentations  on 
a part  cannot  do  much,  if  anything,  else  but  attend  to 
them.  The  fomentations  need  to  be  changed  about  every 
fifteen  minutes  or  at  the  outside  every  half  hour.  Always 
have  the  fresh  fomentation  at  the  bedside  before  re- 
moving the  cold  one. 

In  the  absence  of  a properly  made  stupe  wringer  a 
heavy  towel  doubled  may  be  used,  and  the  ends  twisted 
to  press  the  water  out. 

Laudanujn  is  often  added  to  the  water  in  preparing 
hot  fomentations,  especially  in  cases  of  severe  pain.  The 
doctor  will  always  order  this  treatment  and  prescribe 
the  amount  of  laudanum  which  should  be  used.  But  in 
the  fomentation  wrung  out  of  plain  hot  water,  and 
changed  frequently,  the  home  nurse  has  a valuable 
remedy  especially  useful  in  cases  of  severe  abdominal 
pain,  or  pain  in  the  bladder,  or  rectum.  It  can  also  be 
applied  to  arm,  leg,  or  chest,  but  should  not  be  applied 
where  there  is  an  open  wound. 

Turpentine  stupes  are  frequently  prescribed  in  case  of 
abdominal  distention  in  typhoid  fever,  or  in  inflammation 
in  the  abdominal  region.  The  turpentine  is  sometimes 
put  into  the  water,  using  about  a teaspoonful  to  a quart, 
before  the  flannel  is  wrung  out,  but  this  method  carries 


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with  it  more  danger  of  blistering  from  the  turpentine. 
The  turpentine  should  be  used  only  about  once  in  four 
times.  A better  method  is  to  mix  two  parts  of  olive  oil 
(lard  will  do)  with  one  part  of  turpentine,  and  apply  to 
the  skin  about  every  three  to  six  hours,  and  apply  over 
this  a fomentation  using  only  plain  hot  water. 


Fig.  27. — Wringing  hot  fomentations  with  towel. 


Antiseptic  compresses  are  used  hot  in  case  of  wounds  of 
various  kinds,  also  bruises,  to  soften  the  tissue,  relieve 
pain,  and  check  the  growth  of  germs. 

The  term  antiseptic'^  means  opposed  to  the  growth 
of  germs.  Chemicals  such  as  creolin,  carbolic  acid, 
bichloride,  green  soap,  etc.,  are  added  to  the  water. 
8alt  solution  is  an  antiseptic  solution  and  one  very  fre- 
quently used.  Absorbent  cotton,  clean  gauze  or  soft 
clean  old  linen,  are  wrung  out  of  the  hot  solution, 
a])plied  to  the  part,  covered,  and  renewed  frequently. 

An  eye-bath  is  one  of  the  simplest  and  most  effective 
treatments  for  aching,  tired,  or  inflamed  eyes.  Take  a 


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small  cup;  fill  it  with  water  as  hot  as  can  be  borne,  and 
hold  the  eye  down  in  it..  This  treatment  continued  for 
at  least  five  minutes  for  each  eye,  and  repeated  two  or 
three  times  a day  gives  much  relief  in  cases  of  simple 
inflammation  of  the  eye. 

Points  To  Be  Remembered. — Poultices  may  do  harm 
if  proper  precautions  are  not  observed  in  making  and 
applying  them. 

A poultice  spread  thinly  cools  much  more  quickly 
than  a thick  one. 

Always  be  careful  when  poulticing  to  cover  the  poultice 
as  directed,  to  prevent  the  heat  escaping. 

A hot  water  bag  may  be  laid  over  the  poultice  to  help 
to  retain  the  heat. 

Smear  the  skin  with  vaselin  or  lard  or  cold  cream 
before  applying  the  poultice. 

A fomentation  or  stupe  that  is  cool  enough  to  be 
wrung  out  with  the  hands  is  too  cool  to  do  any  good. 

In  applying  either  a poultice  or  fomentation  be  sure  to 
let  it  down  by  degrees  on  the  part  and  withdraw  the 
hands  from  under  gradually. 

Remember  it  is  the  heat  with  the  moisture  which 
gives  relief,  and  be  very  careful  to  guard  against  heat 
escaping. 

REVIEW  QUESTIONS. 

1.  What  effects  are  poultices  intended  to  produce? 

2.  How  should  a linseed  poultice  be  made  and  applied  ? 

3.  Mention  some  general  rules  that  should  be  observed  in  regard 
to  poultices  in  general. 

4.  If  asked  to  prepare  a bran  poultice  how  would  you  do  it  ? 

5.  Describe  the  method  of  preparing  and  applying  a hot  fomen- 
tation to  the  abdomen. 

6.  What  precaution  should  be  used  in  preparing  a turpentine 
stupe  ? 

7.  Mention  the  general  rules  that  must  be  observed  in  using  stupes 
if  one  is  to  get  the  best  results. 

8.  For  what  purposes  are  antiseptic  compresses  used? 

9.  How  should  an  antiseptic  compress  be  prepared  and  applied  ? 

10.  Mention  a simple  treatment  for  an  inflamed  eye  and  tell  how 

it  should  be  taken. 


CHAPTER  XIV. 


THE  GIVING  OF  MEDICINES. 

Demonstration  and  Practice  Work. — Measuring  fluid  medicines* 
Administration  of  powder,  capsule,  castor  oil,  seidlitz  powder, 
suppository,  iodin,  liniments. 

Most  medicines  are  given  by  the  mouth,  and  unless 
orders  to  the  contrary  are  received,  it  is  general^  under- 
stood that  medicines  are  to  be  given  that  way. 

Care  of  Medicines. — Carelessness  about  medicines  in  a 
home  is  a sure  sign  of  lack  of  intelligence.  Those  who 
know  most  about  drugs  and  their  uses  are  most  careful 
that  all  bottles  are  properly  labeled  and  kept  in  a safe 
place.  The  custom  of  making  the  top  shelf  of  the  pan- 
try or  cupboard,  a dumping  ground  for  a miscellaneous 
collection  of  drugs  labeled  and  unlabeled,  or  of  leaving 
bottles  on  the  sideboard,  or  window  ledge,  within  reach 
of  children,  cannot  be  too  strongly  condemned.  Every 
little  while  one  sees  a newspaper  report  of  some  child 
that  has  come  to  an  untimely  end,  through  the  careless- 
ness of  somebody,  by  getting  hold  of  a bottle  or  box  of 
some  poisonous  drug.  One  of  the  recent  cases  reported 
was  that  of  a little  two  year  old  toddler  who  had  pulled 
open  a sewing  machine  drawer,  found  therein  a small 
bottle  of  laudanum,  and  drunk  the  contents.  Such 
accidents  are  of  far  too  frequent  occurrence. 

It  is  not  uncommon  to  find  in  the  drug  collection  of 
some  other  wise  wellkept  homes,  a motley  array  of  bottles 
and  boxes  each  containing  some  drug  preparation  which 
the  housewife  or  home  nurse  thinks  may  come  in  handy 
some  time.  Some  of  these  bottles  date  back  for  from  five 
to  ten  years.  There  is  probably  on  some  of  them  the 
name  of  the  doctor  and  druggist  with  perhaps  the  illumi- 

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119 


nating  direction  teaspoonful  three  times  a day/’ 
There  is  of  course  nothing  to  say  what  the  nature  of  the 
medicine  is,  or  what  it  is  to  be  used  for.  It  might  be  for 
rheumatism,  or  biliousness,  or  nosebleed,  or  colic. 

Be  careful,  is  therefore  the  first  and  most  important 
rule  in  regard  to  medicines. 

Medicine  will  enter  into  the  circulation  and  act  more 
quickly  if  the  stomach  is  empty.  Medicines  given  in 
fluid  form  act  more  quickly  than  if  given  in  the  form  of 
pills  or  powder. 

Promiscuous  experimenting  with  drugs  is  a foolish  and 
unsafe  practice.  Many  much  lauded  headache  powders 
contain  substances  that  are  powerful  heart  depressants, 
and  many  deaths  have  occurred  from  their  use. 

Most  of  the  pain-relieving  drugs  are  violent  poisons. 
They  act  by  stupefying  and  temporarily  poisoning  the 
nerve  centers.  Continued  use  of  opium  and  many  other 
drugs  given  to  relieve  pain  usually  ends  in  habit.  The 
writer  has  seen  a child  of  four  who  was  a confirmed 
paregoric  fiend,  clamoring  incessantly  to  be  put  under  the 
influence  of  the  drug.  Adults,  especially  those  who 
have  chronic  headache  or  chronic  disease  of  any  kind 
easily  become  addicted  to  bromides  and  other  sleep 
producing  medicines. 

Alcohol  is  a powerful  drug  which  needs  to  be  used  with 
great  caution.  It  is  by  no  means  the  cure-all  which 
many  believe  it  to  be,  and  often  adds  to  the  disease  it  is 
used  to  help.  Over-stimulation  may  easily  be  disastrous, 
and  it  is  unwise  to  add  alcoholic  poisoning  to  other  poisons 
which  the  system  may  be  laboring  to  combat  unless  it  is 
definitely  ordered  by  the  doctor.  When  it  is  ordered  it 
should  be  measured  and  handled  as  carefully  as  any 
other  medicine.  Do  not  give  it  promiscuously  on  the 
principle  that  if  a little  is  good,  more  must  be  better. 
Many  families  use  it  in  every  case  of  faintness  and  without 
stopping  to  consider  that  its  effects  may  be  decidedly 
detrimental.  In  head  injuries  it  is  decidedly  dangerous, 
also  in  most  cases  of  serious  hemorrhage  and  in  various 


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other  conditions.  When  alcohol  is  ordered  the  nurse 
should  get  definite  instructions  from  the  doctor  regard- 
ing: 

1.  The  time  of  day  and  frequency  of  doses. 

2.  The  quantity  at  each  dose. 

3.  Whether  it  is  to  be  diluted  or  not. 

4.  The  time  the  alcohol  treatment  is  to  cease. 

The  latter  point  is  especially  important,  for  the  habit  is 
soon  acquired.  Every  nurse  who  carelessly  administers 
alcohol  in  any  form  undertakes  the  risk  of  helping  some 
one  to  contract  the  habit. 

Do  not  use  alcohol  for  flavoring  eggnogs  or  foods  of 
any  kind.  Choose  some  other  flavoring  substance.  A 
tablespoonful  of  whiskey  carelessly  added  to  an  eggnog 
for  flavoring,  has  started  afresh  a craving  for  liquor 
that  a man  had  been  fighting  for  years. 

Fluid  Medicines. — 1.  It  is  a general  custom  to  dilute 
with  water  most  fluid  medicines,  but  judgment  should  be 
exercised  as  to  the  amount  of  water  that  is  added.  It  is 
unnecessary  to  prolong  the  unpleasantness  of  a disagree- 
able dose  by  adding  too  much  water. 

2.  It  is  a safe  rule  to  shake  all  bottles  before  measuring 
the  dose.  In  a great  many  mixtures  the  important  part 
of  the  remedy  is  in  the  form  of  a sediment,  the  liquid  be- 
ing simply  the  vehicle  used  to  convey  it. 

3.  Bottles  should  be  carefully  corked  after  the  dose  is 
measured.  Many  medicines  contain  substances  that 
readily  evaporate. 

4.  The  regular  graduated  glasses  and  dropper  should 
be  used  to  measure.  Spoons  vary  in  size  and  are  most 
unreliable  measures. 

5.  When  minims  are  ordered,  they  should  be  measured 
in  the  minim  glass!  Minims  and  drops  mean  very  dif- 
ferent quantities  in  many  medicines. 

6.  Measure  exactly.  Never  guess  at  doses  of  any 
medicines.  A great  many  nurses,  who  measure  other  medi- 
cines very  carefully,  guess  at  doses  of  whisky  or  brandy, 


THE  GIVING  OF  MEDICINES 


121 


and  often  twice  the  quantity  intended  is  given.  Hold 
the  glass  on  a level  with  the  eye  when  measuring. 

7.  Always  pour  from  the  side  of  the  bottle  opposite 
the  label.  This  is  a well-known  rule  that  is  often  dis- 
regarded. 

8.  Give  iron  through  a tube,  as  it  discolors  the  teeth. 
If  no  tube  is  obtainable,  and  it  has  to  be  given  without, 
allow  the  patient  to  brush  his  teeth  with  a solution 
of  soda  bicarbonate  and  water  afterward. 

9.  A little  ice  held  in  the  mouth  before  a disagreeable 
dose  helps  to  dull  the  sense  of  taste  and  renders  it  less 
unpalatable.  Vichy  or  seltzer  are  excellent  for  removing 
a disagreeable  lingering  taste. 

10.  Always  keep  a separate  glass  for  very  strong-smell- 
ing substances,  such  as  cod-liver  oil. 

General  Precautions, — Familiarity  with  drugs  is  apt 
to  lead  to  carelessness  in  handling  and  using,  unless  em- 
phatic teaching  and  instructions  are  given.  If  the 
following  general  precautions  regarding  all  drugs  are 
observed,  accidents  from  wrong  doses  will  rarely,  if 
ever,  happen. 

1.  Remember  that  there  is  an  element  of  danger  in 
every  drug. 

2.  Read  the  doctor’s  directions  about  drugs.  Be  sure 
that  you  understand. 

3.  Never  give  or  use  a drug  of  any  kind  that  is  not 
plainly  labeled. 

4.  Never  give  a drug  in  the  dark  or  in  a dim  light. 
Neglect  of  this  precaution  has  caused  numerous  ac- 
cidents. 

5.  Always  read  the  label  twice  before  pouring  out 
the  dose  and  again  before  giving  it.  Violation  of  this 
rule  is  the  most  frequent  cause  of  deaths  from  wrong 
doses. 

6.  Keep  your  mind  on  the  work  in  which  you  are  en- 
gaged. 

7.  Measure  the  dose  accurately.  Give  no  more  and  no 
less  than  the  order  calls  for. 


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8.  Never  give  a pill,  capsule,  or  tablet  that  has  acci- 
dentally been  spilled  or  escaped  from  its  container. 

9.  Never  give  a medicine  which  you  have  a shadow  of 
a doubt  about.  If  you  are  not  sure,  and  there  is  no  one 
at  hand  to  inquire  of,  it  is  better  to  omit  the  dose. 

10.  Never  jump  at  conclusions  regarding  fractional 
doses.  For  instance,  do  not  give  two  1 / 30-grain  tablets 
of  strychnin  because  1/60  is  ordered,  and  you  happen  to 
know  that  twice  30  are  60.  Stop  long  enough  to  cal- 
culate how  much  2/30  grain  really  is.  Innumerable 
accidents  have  occurred  with  tablet  medicines  in  this 
way  because  of  mistakes  in  arithmetic. 

11.  Give  the  medicine  on  the  hour  it  is  ordered. 

Sleep-producing  Medicines. — Practically  all  sleep- 
producing  medicines  are  ordered  conditionally.  There 
is  a subtle  danger  in  every  one  of  them  that  is  recognized 
by  all  who  have  had  experience,  and  they  are  regarded 
as  emergency  remedies  to  be  given  if  the  need  is  impera- 
tive, and  after  ordinary  simple  measures  to  secure  sleep 
have  been  tried  and  proved  unsuccessful.  When  it  is 
necessary  to  give  them,  have  the  patient  ready  for  sleep, 
treatments  all  attended  to,  bed  throughly  comfortable, 
temperature  of  the  room  right,  visitors  excluded.  If 
these  have  to  be  attended  to  after  the  dose  has  been 
given,  it  may  have  lost  its  effect  before  the  patient  is 
allowed  to  sleep. 

Giving  Medicines  to  Children. — In  the  case  of  children 
who  lie  in  a half-unconscious  condition,  it  is  impossible  to 
give  medicines  in  the  ordinary  way.  Much  can  be 
accomplished  in  these  cases  by  using  a medicine-dropper 
and  taking  plenty  of  time.  The  mouth  and  teeth 
can  be  held  open  slightly  and  the  medicine  slowly 
dropped  in.  Usually,  with  children,  it  is  sufficient  to 
insert  the  dropper  beside  the  teeth,  and  when  the  con- 
tents are  slowly  dropped  they  will  usually  be  swallowed. 

Each  sick  child  is  more  or  less  of  a problem,  but  there 
arc  a few  general  principles  that  apply  to  children  as  a 
class.  Sometimes  firmness  and  insistence  on  being 


THE  GIVING  OF  MEDICINES 


123 


obeyed  will  be  all  that  is  needed  in  giving  medicine. 
When  that  fails,  bribery  of  some  form  will  often  succeed. 
It  is  not  good  moral  training  to  bribe  a child  to  do 
what  he  manifestly  should  do  without  bribery,  but 
sickness  is  not  the  time  to  teach  good  habits.  If  a child 
is  persistently  obstinate,  it  is  unwise  to  spend  time  in 
pleading  or  arguing.  The  last  resort  in  such  cases,  if 
it  is  important  for  him  to  get  the  medicine,  is  to  hold  the 
nose  and  give  the  medicine.  Wrap  a bath-towel  about 
the  body  to  confine  the  arms,  hold  the  nose  gently,  and 
when  the  mouth  is  opened  for  breathing,  insert  the  spoon 
as  far  back  in  the  mouth  as  possible,  empty  slowly, 
and  withdraw  it.  If  a child  persistently  struggles  and 
resists,  the  matter  is  one  to  be  reported  to  the  physician. 
Very  often  the  struggle  and  consequent  exhaustion  will 
overbalance  any  good  the  medicine  might  do. 

In  giving  medicine  to  young  babies,  press  the  chin 
backward  and  downward  with  the  finger,  and  the  mouth 
will  usually  be  opened  sufficiently  to  pour  in  the  medicine 
gently. 

Alcoholic  stimulants  should  be  diluted  eight  times  be- 
fore administration  to  children. 

Doses  for  Children. — A common  rule  for  computing 
doses  for  children  under  twelve  years  of  age  is:  Add 

12  to  the  child's  age  and  divide  the  age  by  the  sum. 
For  example,  if  a child  is  four  years  of  age,  the  dose 

4 

would  be  figured  in  this  way:  12  ~ ^ 

adult  dose  would  be  an  average  dose.  This  rule  does 
not  apply  to  castor  oil  nor  calomel,  of  which  larger 
relative  doses  are  borne  by  children  than  of  most  other 
drugs. 

Pills. — If  difficulty  is  experienced  in  swallowing  a 
pill,  the  addition  of  a small  bit  of  bread  to  its  bulk  will 
usually  remove  it,  or  the  pill  may  be  disguised  in  pre- 
served fruit  for  children.  Pills  should  be  placed  far 
back  on  the  tongue  and  followed  at  once  by  a little  water. 

Powders. — There  can  be  no  fixed  rule  for  giving  pow- 


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ders.  Effervescent  powders  or  crystals  are  dissolved 
in  cold  water  (usually  at  least  one-half  a tumblerful) 
at  the  bedside  and  taken  before  the  bubbling  ceases. 

Seidlitz  powders  are  prepared  usually  in  white  and 
blue  papers.  The  contents  of  the  papers  are  dissolved 
in  cold  water,  in  separate  glasses.  Before  giving  to 
the  patient  they  are  mixed.  ‘This  causes  effervescence. 
The  mixture  should  be  taken  before  effervescence  ceases. 

There  are  several  kinds  of  powders  which  will  not 
dissolve  in  water.  These  are  given  dry  on  the  tongue 
and  followed  with  water. 


Fig.  28. — Castor  oil  in  glass  ready  for  administration.  {De  Lee.) 

Capsules,  pills,  and  tablets  are  given  from  a spoon 
followed  by  water.  Arrange  the  capsule  or  tablet  on 
the  spoon  on  a small  tray  or  plate,  with  a small  glass  of 
water  beside  it  before  carrying  it  to  the  patient. 

Oils. — The  disagreeable  taste  of  oils  may  be  lessened 
in  various  ways.  Castor  oil  may  be  given  to  children 
in  hot  milk  or  a little  coffee.  Grape-juice,  and  orange 
or  lemon  flavor  are  favorite  vehicles. 

It  is  better  to  moisten  the  sides  of  the  glass  with  the 


THE  GIVING  OF  MEDICINES 


125 


wine  or  diluted  juice,  pour  a couple  of  drams  in  the 
bottom  of  the  glass,  drop  the  oil  carefully  in  the  center, 
add  another  dram  of  the  juice,  and  direct  that  it  be 
swallowed  quickly. 

Ice-water,  with  a few  drops  of  peppermint,  taken  before 
and  after  meals  helps  to  dull  the  sense  of  the  taste. 

A strong  lemonade  is  one  of  the  best  methods  of  dis- 
guising the  disagreeable  taste.  Put  part  of  it  in  the 
bottom  of  the  glass,  add  the  castor  oil,  then  the  remainder 
of  the  lemonade.  Just  before  drinking,  stir  in  a half 
teaspoon  of  baking  soda.  The  patient  will  not  know 
he  has  taken  castor  oil  if  he  is  not  told. 

Turpentine  and  croton  oil  are  best  given  on  sugar 
from  a spoon,  followed  by  a mouthful  of  water. 


Fig.  29. — Method  of  giving  a hypodermic  injection.  {Thornton.) 

Hypodermic  Injections. — Medicines  are  given  by 
hypodermic  injection  when  very  quick  action  is  desired, 
and  in  some  cases  in  which  the  patient  is  liable  to  vomit 
medicines  given  by  the  mouth.  As  a rule  only  powerful 
drugs  are  given  in  this  way.  A hypodermic  syringe  is 
needed  to  give  these  injections.  The  cases  are  rare  in 
which  the  home  nurse  will  be  required  to  give  medicine 
in  this  way.  She  should  never  attempt  it  on  her  own 
responsibility,  never  without  being  shown  how  by  the 
doctor  or  other  responsible  person,  and  never  without 
fully  understanding  the  dangers  and  the  harm  that  might 
follow. 

Points  to  be  Remembered. — If  you  would  avoid  serious 
accidents  keep  all  drugs  labeled  and  always  out  of  the 


126  HOME  nurse’s  hand-book 

reach  of  children.  See  that  medicine  cupboards  are 
kept  locked. 

Medicines  do  not  cure.  Nature  must  work  her  own 
cure  and  the  promiscuous  experimenting  with  drugs  is 
often  a hindrance. 

Most  pain  relieving  drugs  are  violent  poisons  and 
should  never  be  used  except  as  ordered  by  the  family 
physician  who  understands  the  special  needs  of  the 
patient. 

Measure  medicines  exactly.  Every  household  should 
have  a small  graduated  measuring  glass  to  be  used  in 
preference  to  spoons  which  vary  in  size. 

Study  carefully  the  directions  given  as  to  how  to  avoid 
mistakes  and  accidents  in  giving  medicines.  Numerous 
accidents  and  deaths  have  been  caused  by  giving  or 
taking  medicine  out  of  the  wrong  bottle  in  the  dark  or  in 
a dim  light. 

There  is  a refined,  neat  way  of  giving  medicines,  and 
a slovenly  way  which  is  an  index  to  the  character  of  a 
nurse  and  the  general  quality  of  her  work.  Try  to 
cultivate  refined,  neat  habits. 

Before  giving  sleep-producing  medicines  to  any  patient, 
see  that  conditions  are  all  favorable  for  sleep,  quietness, 
darkness,  comfort,  good  air  in  the  room,  all  visitors 
banished,  duties  done  for  the  time. 

If  you  are  ever  in  doubt  about  whether  to  give  a med- 
icine or  not,  it  is  better  to  omit  it  till  the  doctor  can  be 
consulted. 

If  you  give  the  wrong  dose,  you  may  never  be  able  to 
undo  the  results  of  the  mistake. 

REVIEW  QUESTIONS. 

1.  AMiat  precautions  would  you  use  in  regard  to  the  care  of  all 
medicines  in  the  home  ? 

2.  Give  ten  rules  that  should  be  observed  in  handling  and  giving 
fluid  medicines. 

3.  Mention  some  general  precautions  you  would  use  in  giving  all 
kinds  of  medicines. 


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127 


4.  What  special  rules  would  you  use  in  regard  to  sleeping  medi- 
cines ? 

5.  How  would  you  compute  the  dose  that  should  be  given  to  a 
child  ? 

6.  How  would  you  give  medicine  to  a child  who  was  half  un- 
conscious ? 

7.  If  a patient  had  difficulty  in  swallowing  a pill  how  would  you 
manage  it  ? 

8.  Describe  your  method  of  administering  a seidlitz  powder. 

9.  How  should  capsules  and  tablets  be  administered  ? 

10.  Mention  one  way  of  disguising  the  disagreeable  taste  of  castor 

oil. 


CHAPTER  XV. 


EVERY-DAY  CARE  OF  THE  BABY. 

Demonstration  and  Practice  Work. — Bathing  and  dressing  a baby. 
Making  and  care  of  a baby’s  bed. 

Of  all  the  duties  that  fall  to  the  lot  of  woman,  the  care 
and  proper  rearing  of  children  is  the  most  important. 
Of  all  professions  open  to  women,  motherhood  is  second 
to  none.  Yet  it  is  termed  and  rightly  so  the  unskilled 
profession.’^  The  price  of  ignorance  in  how  to  take  care 
of  babies  is  suffering,  disease,  and  death.  It  is  esti- 
mated that  every  year  in  the  U.  S.  375,000  babies  die, 
mainly  from  diseases  that  could  have  been  prevented  if 
their  mothers  had  known  how  to  prevent  them.  It 
should  surely  be  considered  as  important  for  a girl  to 
be  taught  how  to  take  care  of  a baby  as  to  be  taught 
algebra,  or  French  or  history. 

The  baby’s  clothing  is  among  the  first  essentials  that 
need  to  be  considered.  Comfortable  clothing  for  the  baby 
means  clothes  that  are  loose,  soft,  warm  enough,  clean, 
and  not  too  fussy  or  elaborate.  They  should  be  made 
so  that  they  are  easy  to  get  off  and  on.  Swaddling  clothes 
for  babies  which  are  common  in  some  countries,  are 
objectionable  for  several  reasons.  Among  the  chief 
reasons  are  that  the  baby  is  wrapped  up  like  a bundle, 
in  such  a way  that  motion  of  the  legs  is  hindered;  and 
it  is  hard  to  keep  the  body  clean. 

The  baby’s  first  clothes  usually  consist  of: 

A binder  about  20  inches  long  and  5 inches  wide;  a shirt; 
a flannel  pinning  blanket”  or  Imrrow  coat.  (This 
consists  of  a piece  of  flannel  about  29  inches  square 
plaited  into  a band  about  18  by  6 inches  and  open  in 
front.  It  is  turned  up  over  the  feet,  and  secured  with 
safety  pins.)  A petticoat;  a dress;  a diaper;  a woolen 

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129 


blanket  or  shawl;  a night  dress.  The  number  of  these 
articles  that  should  be  provided  will  depend  on  the 
family  purse,  and  how  often  the  washing  of  the  clothes 
can  be  done. 

The  material  for  the  hinder  should  be  very  soft  white 
flannel  or  flannelette.  The  edges  should  be  pinked 
rather  than  hemmed  if  only  one  thickness  is  used.  If 
flannelette  is  used  the  bands  should  be  double,  and 
seamed  together  on  one  side.  After  the  first  two  months 
a knitted  circular  binder  is  preferable. 

The  shirts  for  a winter  baby  are  best  made  of  soft 
white  flannel.  In  summer  a finely  woven  cotton  shirt 
may  be  substituted.  If  the  shirts  are  made  at  home 
the  hem  should  be  made  on  the  outside  as  the  hem  next 
to  the  baby’s  tender  skin  may  cause  soreness.  The 
most  important  points  about  shirts  are  that  they 
should  be  warm,  clean,  and  of  a material  that  will  not 
irritate  the  skin.  A quality  of  soft  flannelette  is  pref- 
erable to  coarser  flannel. 

All-wool  shirts  are  almost  certain  to  shrink  in  wash- 
ing, and  become  tight  and  uncomfortable.  In  hot 
weather  the  all-wool  garment  is  very  likely  to  irritate 
the  baby’s  skin.  For  these  reasons  a shirt  made  of  a 
mixture  of  cotton  and  wool  is  often  preferable.  If  fine 
wool  or  mixed  shirts  cannot  be  obtained  the  next  best 
thing  is  a fine  soft  white  flannelette.  Little  babies  need 
to  be  kept  very  warm.  The  shirts  should  be  made  with 
long  sleeves  and  to  come  well  up  to  the  neck.  Chilling 
of  the  chest  and  abdomen  should  be  prevented.  To 
keep  the  shirt  from  slipping  up  and  leaving  the  chest 
and  abdomen  bare,  pin  it  to  the  diaper. 

The  petticoat  and  dress  for  little  babies  are  made  long, 
partly  for  the  sake  of  warmth  and  partly  to  make 
handling  of  the  baby  easier.  The  petticoat  should  be  of 
flannel  or  heavy  flannelette.  If  the  skirts  of  the  petti- 
coat are  made  too  long  it  hinders  the  exercise  of  the 
baby’s  legs.  From  six  to  ten  inches  below  the  feet 
is  long  enough. 

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The  dress  material  will  vary  according  to  climate  and 
season.  It  should  be  soft,  with  no  rough  edges  anywhere, 
and  loose  enough  for  comfort. 

The  diapers  should  be  of  soft,  light,  absorbent  material. 
For  the  first  three  months  a diaper  one  yard  long  by 
one  half  yard  wide  will  be  sufficient.  As  the  baby 
grows  the  diaper  must  be  larger. 

The  diapers  should  be  changed  as  soon  as  they  are  wet 
or  soiled;  In  washing  them  a good  quality  of  soap  should 
be  used  without  too  much  lye;  they  should  be  rinsed 
thoroughly  in  several  waters  to  remove  all  traces  of  soap. 
Carelessness  about  washing  and  rinsing  of  a baby’s 
diapers  has  often  caused  a severe  inflammation  of  the 
baby’s  tender  skin,  around  the  hips,  abdomen  and  legs. 

Short  clothes  are  substituted  for  long  at  about  three 
or  four  months  of  age.  When  it  can  be  avoided  the 
change  should  not  be  made  in  cold  weather.  Shoes 
and  stockings  will  then  need  to  be  provided.  The  stock- 
ings should  be  long  enough  to  come  up  well  over  the  knees. 
These  are  pinned  to  the  diaper  with  safety  pins.  The 
shoes  should  be  carefully  chosen  so  that  they  do  not 
pinch,  chafe,  or  bind  the  foot.  They  should  have  broad 
toes.  Care  should  be  used  from  the  beginning  to  keep 
the  shoes  left  and  right. 

The  Baby’s  Bath. — Every  baby  (unless  it  is  so  weak 
that  it  should  not  be  handled)  should  have  its  daily  bath. 
Its  own  wash  cloth,  towels,  and  soap  should  be  pro- 
vided, and  kept  separate  from  those  used  by  the  rest  of 
the  family. 

The  bath  hour  may  be  either  in  the  morning  or  evening. 
It  should  not  be  right  after  the  baby  has  been  fed.  If 
the  baby  is  troublesome  at  night,  an  evening  bath  will 
tend  to  better  sleeping  habits.  In  the  morning,  if  the 
full  bath  is  given  at  night,  the  face,  hands,  and  buttocks 
should  be  washed. 

The  room  in  which  the  bath  is  to  be  given  should  be 
warm  and  free  from  draughts. 

The  clean  clothing  should  be  well  aired,  all  ready  to 


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put  on.  A tub  or  large  basin  of  lukewarm  water  should 
be  ready,  with  soft  towels,  and  wash  cloths,  pure  soap, 
free  from  injurious  ingredients,  and  some  bits  of  old 
cotton  or  linen  for  washing  the  baby^s  mouth. 

The  head,  neck  and  ears  are  washed  first.  The  scalp 
needs  to  be  soaped  daily  to  ensure  cleanliness.  When 
the  baby  is  a month  old  he  can  be  put  in  the  tub  or  basin 
to  have  the  body  washed.  Tub  bathing  is  always  pref- 
erable for  larger  babies. 

The  drying  is  done  by  soft  patting  rather  than  vigorous 
rubbing.  Special  care  should  be  taken  in  the  drying  of 
the  armpits  and  groin,  where  chafing  is  liable  to  occur. 

Chafing  is  caused  chiefly  by  failure  to  keep  dry  the 
folds  of  skin  in  the  armpits,  groin,  about  the  neck  and 
ears,  and  sometimes  behind  the  knees,  and  at  the  elbow- 
joints;  by  lack  of  cleanliness;  or  by  too  rough  clothing. 
To  guard  against  it  in  the  folds  of  the  skin,  these  points 
at  which  chafing  is  liable  to  occur  are  dusted  with  a fine 
powder.  Talcum  powder  is  commonly  used.  If  the 
skin  around  these  parts  is  dry  and  inclined  to  peel,  a 
little  cold  cream,  or  zinc  oxide  ointment  may  be  used 
instead  of  powder. 

Chafing  in  a baby  is  nearly  always  due  to  neglect.  It 
shows  at  once  that  a baby^s  mother  or  nurse  has  not  given 
it  the  intelligent  and  constant  care  it  should  have. 

To  wash  a hahfis  mouth,  a little  clean  lukewarm  water 
with  a pinch  of  borax  dissolved  in  it  is  used.  A bit  of 
clean  cotton  wrapped  around  the  little  finger  is  dipped 
into  the  water  and  the  inside  of  the  mouth  swabbed  out 
at  least  twice  a day.  Babies  are  very  liable  to  develop 
sore  spots  on  the  tongue.  These  can  be  prevented  by 
proper  care  and  careful  daily  washing.  The  utmost 
gentleness  should  be  used  in  doing  the  washing,  as  it  is 
easily  possible  by  too  vigorous  rubbing,  to  break  the 
delicate  lining  of  the  mouth. 

The  eye-lids  of  a little  baby  sometimes  become  red,  and 
swollen,  with  sometimes  a creamy  discharge.  This  is 
always  a serious  condition  and  the  doctor  should  be  told 


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of  it  at  once.  Many  babies  have  become  blind  because 
the  doctor  was  not  called  soon  enough  to  treat  the  sore 
eyes. 

In  putting  on  the  baby^s  clothes  after  a bath,  care  should 
be  taken  not  to  have  the  binder  too  tight.  Much  dis- 
comfort is  caused  the  baby  by  a binder  or  bandage  so 
tight  that  neither  lungs  nor  abdomen  have  a chance  to 
expand.  It  should  be  free  from  wrinkles  and  should  be 
changed  as  often  as  it  becomes  soiled  or  wet.  Its  chief 
use  after  the  first  month  is  to  prevent  chilling  of  the  abdo- 
men. If  it  is  not  managed,  so  that  it  does  this,  it  had 
better  be  discarded.  Safety  pins,  not  too  large,  should 
be  used  to  keep  it  in  place.  Common  straight  pins 
should  never  be  used  in  a baby’s  clothes. 

Sleep. — A very  young  baby  should  sleep  most  of  the 
time.  As  it  grows,  it  will  sleep  less.  When  it  is  six 
months  old  it  should  take  a morning  nap  of  from  one  and 
a half  to  three  hours.  Regular  hours  for  its  sleeping 
should  be  planned  and  adhered  to  as  much  as  possible. 
Some  babies  from  six  months  to  a year  old  take  an  after- 
noon nap,  but  it  is  better  to  put  the  baby  to  bed  early 
(about  6 p.  M.)  for  the  night,  and  try  to  teach  it  to  sleep 
well  at  night,  than  to  allow  it  to  sleep  in  the  afternoon, 
and  stay  up  late  in  the  evening. 

The  Baby’s  Bed. — The  baby  from  the  beginning  should 
have  its  own  little  bed.  It  may  be  a basket  or  a cradle  or 
a box  but  any  of  these  or  even  a thick  cotton  quilt  folded 
and  laid  on  two  chairs  is  preferable  to  having  it  sleep, 
with  its  mother.  Both  will  rest  better  if  the  baby  has 
a bed  of  its  own.  This  is  especially  true  in  summer. 
A great  many  babies  have  been  killed  by  being  smothered 
between  two  adults,  or  by  being  overlaid  by  its  mother 
or  father  during  a heavy  sleep. 

The  hair  mattress,  covered  with  a rubber  sheet  over 
which  is  laid  a quilted  pad,  is  probably  the  most  desirable 
for  a bed.  If  the  hair  mattress  and  crib  are  not  avail- 
able, a sack  filled  with  clean  straw  is  probably  the  next 
best  thing.  This  also  should  be  covered  with  a rubber 


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sheet  which  is  soaked  in  hot  suds  at  intervals.  Over 
this  a thick  quilted  pad  should  be  placed. 

Feather  pillows  when  used  for  a baby^s  bed  cannot  be 
kept  clean  and  sanitary.  A small  feather  pillow  for 
the  head  is  not  so  objectionable,  though  a hair  one  is 
preferable. 

Air  is  the  first  great  essential  to  life.  No  one  can  live 
many  moments  without  air,  and  no  baby  can  be  healthy 
and  strong  and  grow  as  it  should  without  plenty  of  fresh 
air.  It  is  not  enough  that  it  is  sent  out  daily  in  its  car- 
riage for  an  airing,  but  the  air  in  the  room  in  which  it 
eats  and  sleeps  should  be  kept  pure  as  possible,  and  as 
free  as  possible  from  bad  odors.  Except  in  severely  cold 
weather,  it  is  a good  plan  to  wrap  the  baby  up  warmly, 
and  put  it  in  its  buggy  to  sleep  out  of  doors  during  its 
daily  naps.  At  night  the  window  of  the  room  in  which  it 
sleeps  should  be  opened  either  at  the  top  or  bottom,  to 
let  in  the  fresh  air. 

Points  to  be  Remembered. — The  baby^s  clothing 
should  be  loose,  soft,  warm  enough  but  not  too  warm, 
clean,  and  not  too  elaborate. 

The  binder  should  not  have  rough  edges  next  to  the 
skin  and  should  not  be  too  tight. 

Shirts  should  have  high  necks,  long  sleeves,  and  be  of 
a material  that  will  not  irritate  the  skin. 

Shirts  and  bands  should  come  well  down  over  the 
abdomen  and  should  be  pinned  so  as  to  prevent 
chilling. 

Skirts  of  petticoats  and  dresses  should  not  be  so  long 
that  the  baby  cannot  exercise  his  legs. 

Diapers  should  be  changed  as  soon  as  they  are  wet  or 
soiled.  They  should  be  well  rinsed  after  washing  to 
remove  every  trace  of  soap. 

Badly  washed  diapers  may  cause  inflammation  of  the 
skin  around  the  hips. 

Stockings  should  come  well  up  over  the  knees.  Except 
in  the  warmest  weather  the  baby’s  legs  and  knees  should 
not  be  left  bare. 


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Shoes  should  have  broad  toes,  and  left  and  right  kept 
for  proper  feet  from  the  beginning. 

The  baby  should  have  a bath  every  day. 

Crusts  on  a baby^s  head  are  a sign  that  it  has  not  been 
kept  clean. 

Chafing  of  the  skin  at  the  arm-pits  or  groin  is  usually 
caused  either  by  lack  of  cleanliness  or  by  too  rough  cloth- 
ing. It  can  be  prevented  by  keeping  the  parts  dry  and 
clean. 

Babies  are  prone  to  develop  small  sores  in  the  mouth. 
To  prevent  this  the  baby’s  mouth  should  be  washed 
gently  every  day,  at  least  twice. 

Every  baby  needs  plenty  of  fresh  air  if  it  is  to  grow  and 
be  healthy  and  strong. 

REVIEW  QUESTIONS. 

1.  Describe  an  average  outfit  of  clothing  for  a baby. 

2.  About  what  age  should  a baby  be  put  in  short  clothes? 

3.  Mention  some  precautions  you  would  use  in  regard  to  a baby’s 
shirts,  diapers  and  shoes. 

4.  How  would  you  prepare  for  and  give  a bath  to  a baby  ? 

5.  What  precautions  would  you  use  in  regard  to  the  binder  ? 

6.  What  measures  would  you  use  to  prevent  chafing  in  a baby? 

7.  Why  is  it  important  to  wash  a baby’s  mouth,  and  how  would 
you  do  it  ? 

8.  Describe  what  you  would  consider  proper  arrangements  in 
regard  to  baby’s  sleep. 

9.  Why  is  fresh  air  in  the  sleeping  and  living  rooms  important 
for  every  baby? 

10.  What  would  you  do  if  you  noticed  that  a baby’s  eyes  were 
sore  or  inflamed? 


CHAPTER  XVI. 


EVERY-DAY  CARE  OF  THE  BABY  (continued). 

Demonstration  and  Practice  Work. — How  and  how  not  to  carry  a 
baby.  How  to  apply  artificial  heat  to  a baby.  Show  picture  of  a 
baby’s  stomach;  tell  its  position  and  explain  why  a baby  vomits 
so  easily  when  the  stomach  is  overfull. 

Feeding. — A baby  will  survive  a great  deal  of  neglect 
in  other  ways  if  it  be  properly  fed.  If  it  be  not  properly 
fed  no  amount  of  attention  in  other  ways  will  compensate 
for  ignorance  or  carelessness  in  this  respect.  The  re- 
sult of  ignorance  or  unwise  feeding  is  usually  a funeral. 
There  are  parents  who  would  not  think  of  experimenting 
with  the  mechanism  of  a ten  dollar  watch  when  it  refuses 
to  do  its  work  properly,  who  nevertheless  experiment 
with  the  delicate  machinery  of  a baby^s  digestive  appa- 
ratus in  a manner  that  is  simply  appalling.  When  there 
are  signs  that  the  baby^s  digestive  organs  are  not  working 
properly,  they  will,  acting  on  the  well  meant  advice  of 
some  neighbor  as  ignorant  as  themselves,  give  it  one 
thing  after  another  in  turn  because  the  neighbor  said 
^4t  did  her  baby  good’’  at  some  previous  time.  It 
requires  but  a very  small  amount  of  promiscuous  experi- 
menting with  a baby’s  food  to  produce  a sick  baby.  The 
only  safe  way,  if  the  baby’s  food  seems  not  to  agree,  is  to 
consult  a reliable  physician  and  follow  his  directions  to 
the  letter. 

The  best  food  for  a baby  is  its  mother’s  milk.  The 
baby  who  is  breast  fed  has  more  than  ten  chances  to  one 
in  its  favor  for  growing  up  strong  and  healthy,  as  com- 
pared to  the  bottle-fed  baby. 

The  baby’s  stomach  at  birth  holds  only  about  two 
tablespoonfuls.  At  six  months  it  holds  about  three- 

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fourths  of  a cupful.  The  baby  needs  to  be  fed  more 
frequently  than  grown  folks  because  its  stomach  is  small, 
but  it  is  a bad  practice  to  train  the  baby  to  expect  to  be 
fed  every  time  it  cries. 

Regular  hours  for  feeding  should  be  established  from 
the  very  beginning.  Every  two  to  two  and  a half  hours 
during  the  day,  and  once  between  ten  o^ clock  and  early 
morning,  are  often  enough  to  feed  the  baby.  After  the 
first  three  months  the  daily  feedings  may  be  three  hours 
apart. 


Fig.  30. — Stomach  of  infant  at  birth,  natural  size.  {J.  P-  C.  Griffith.) 

To  train  the  baby  to  do  without  nursing  at  night  from 
ten  o^ clock  till  early  morning  is  easy,  if  it  is  started  at 
birth  and  it  is  better  for  the  baby,  the  mother,  and  all 
concerned. 

W ater  should  be  offered  to  every  baby  two  or  three  times 
a day.  Quite  often  a baby  cries  because  he  is  thirsty. 
Cool  boiled  water  should  be  given  it  in  preference  to  the 
water  from  the  faucet  or  pump. 

When  the  baby  cries  do  not  think,  every  time  it  is  crying 
from  hunger.  It  may  be  crying  from  indigestion.  If 
more  milk  is  offered  it,  the  warm  milk  entering  the 
stomach  may  relieve  it  for  a time,  only  to  increase  it  in  a 
short  time.  The  baby  may  cry  because  it  is  too  cold  or 


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too  warm;  its  clothing  may  be  wrinkled  and  uncomfort- 
able, or  wet;  colic  or  indigestion  from  overfeeding  may 
cause  it  to  cry.  The  baby  may  be  hungry,  or  it  may  be 
lonesome. 

Gentle  patting  in  the  crib  or  turning  over  to  the  other 
side  will  often  soothe  a nervous  baby.  It  is  never  a good 
plan  to  practice  taking  the  baby  up  every  time  it  cries. 
Babies  who  have  been  trained  to  expect  to  be  taken  up 
every  time  they  cry,  may  easily  become  veritable  little 
tyrants  and  upset  the  peace  of  the  entire  household. 

Colic  is  often  relieved  by  a drink  of  warm  water,  by  a 
hot  flannel  to  the  abdomen,  by  gentle  rubbing  of  the 
abdomen,  beginning  at  the  right  groin  and  going  up  and 
around,  or  by  laying  them  on  the  stomach  over  a hot 
plate  or  a hot  water  bottle.  If  the  pain  persists  an 
enema  to  empty  the  lower  bowel  may  have  to  be  given. 

Drugs  should  never  be  given  to  a baby  to  relieve  pain, 
except  on  the  definite  order  of  a doctor.  Many  of  the 
pain-relieving  medicines  contain  opium  or  some  other 
substance  which  acts  on  the  baby’s  brain  causing  a stupor, 
and  seriously  damaging  the  baby’s  general  health. 

Hundreds  of  babies  are  killed  every  year  as  a result 
of  promiscuous  drugging  on  the  advice  of  neighbors 
and  friends.  Beer,  wine  or  liquor  of  any  kind  should 
never  be  given  to  a baby. 

The  Baby’s  Diet. — Bringing  the  baby  to  the  table 
with  the  family  has  often  proved  to  be  the  first  step 
to  a sickness  which  caused  its  death. 

The  baby  who  is  being  nursed  at  its  mother’s  breast 
does  not  need  potatoes  nor  a pork  rind  to  suck,  nor 
bread  and  gravy,  nor  crackers  and  milk.  If  these  are 
not  given  to  the  baby  by  some  injudicious  person,  he 
will  not  know  anything  about  them,  and  will  not  want 
them. 

It  is  not  unusual  in  some  homes  to  find  that  a baby  of  a 
few  months  has  been  given  beer  or  sausage,  or  a richly 
iced  cake,  or  candy,  or  decaying  fruit.  Cucumber 
pickles  have  been  given  to  a baby  of  a year,  while  boiled 


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tea  and  bread  constitute  a staple  article  of  infants^ 
food  in  thousands  of  homes.  Where  such  blunders  in 
feeding  are  persisted  in,  deaths  among  babies  under 
two  years,  as  might  be  expected,  are  common  occur 
rences. 

A good  general  rule  is  to  give  the  baby  no  solid  food 
till  it  has  teeth.  No  food  should  be  given  a child  which 
it  is  not  able  to  digest,  or  which  will  not  nourish  it. 
The  question  is  not  whether  this  article  will  do  the  baby 
any  harm,  but  will  it  do  it  good?  Until  a child  is  seven 
or  eight  months  old  its  digestive  organs  are  not  able 
to  digest  starchy  foods  or  solid  foods  of  any  kind. 

If  a baby  gains  in  weight,  is  ordinarily  contented, 
does  not  vomit,  his  food  both  in  quality  and  quantity 
must  be  pretty  nearly  right.  It  is  a good  plan  to  weigh 
the  baby  every  month  for  the  first  year. 

Every  change  in  a baby’s  diet  should  be  made  gradu- 
ally. Before  weaning,  it  should  be  gradually  accus- 
tomed to  other  foods.  It  is  a very  bad  plan  to  wean 
a baby  in  hot  weather. 

Teething. — The  process  of  teething  is  purely  natural, 
and  a baby  in  ordinary  good  health  will  have  very  little 
discomfort.  It  is  a common  mistake  to  attribute  all 
sorts  of  symptoms  to  cutting  teeth.”  Babies  have 
been  allowed  to  suffer  and  die  because  the  mother  ig- 
norantly believed  the  fretfulness  of  the  baby,  and  other 
signs  of  illness,  were  due  solely  to  teething.  In  excess- 
ively nervous  or  poorly-nourished  children,  the  coming 
of  the  teeth  may  exaggerate  other  symptoms,  but  if 
the  baby  seems  sick  or  is  unusually  fretful  it  is  well 
to  examine  for  other  causes  of  discomfort. 

The  first  teeth  usually  make  their  appearance  about 
the  sixth  or  seventh  month.  Some  babies  have  their 
first  teeth  earlier  than  this,  and  others  later.  No  teeth 
at  the  end  of  the  first  year  is  a sign  that  his  general  condi- 
tion is  not  as  good  as  it  should  be,  even  if  he  appears 
well.  The  two  lower  central  incisors  usually  come  first. 
There  are  twenty  milk  teeth  or  temporary  teeth.  A 


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baby  a year  old  should,  under  ordinary  conditions,  be 
expected  to  have  at  least  six  teeth.  By  the  time  it  is 
two  and  a half  years  old  it  should  have  all  its  temporary 
teeth.  As  a rule  nature  will  attend  to  the  cutting  of 
teeth  unaided.  The  giving  of  the  baby  a hard  rubber 
to  ''bite  on''  or  the  rubbing  of  the  gums  with  a thimble 
in  an  effort  to  help  the  teeth  through,  are  foolish  practices 
which  do  no  good,  and  may  do  much  harm. 

Comforters  or  Dummies. — The  "dummy"  is  an  un- 
necessary evil,  the  foolish  contrivance  of  some  ignorant 
woman  in  past  ages  whose  example  is  no  safe  guide  for 
the  mothers  and  nurses  of  the  present.  The  " comforter" 
is  a constant  menace  to  the  child's  health,  and  it  usually 
utterly  fails  to  produce  the  desired  "comforting"  result. 
It  was  no  part  of  the  Creator's  plan  that  any  infant  should 
be  kept  constantly  sucking,  exercising  the  muscles  of  its 
mouth  and  jaws  in  all  its  waking  hours.  Such  muscles 
are  over-exercised.  Physicians  have  found  that  babies 
who  have  been  trained  to  acquire  this  habit  are  more 
frequently  the  victims  of  adenoids,  and  other  throat 
troubles  than  other  children.  The  dummy  is  constantly 
dropping  out  of  the  baby's  mouth,  and  he  is  kept  in  con- 
stant agitation  till  some  one  puts  it  back  again.  It 
gathers  to  itself  germs  and  dirt  of  various  kinds  which 
are  carried  into  the  mouth,  there  to  do  their  work  in 
causing  inflammation  and  ulcers  in  the  delicate  lining 
of  the  mouth. 

Exercise. — From  the  time  a baby  is  three  months  old, 
it  is  a good  plan  to  lay  it  flat  on  the  floor  on  a blanket 
every  day  where  there  are  no  draughts  and  let  it  stretch 
and  kick.  If  it  attempts  to  stand  up  on  its  feet  too 
soon,  as  many  active  babies  do,  its  efforts  should  be 
discouraged.  The  bones  are  soft  and  "bow-legs"  may 
be  the  result  of  too  early  attempts  at  standing  or  walking. 
Trotting  the  baby  on  the  knee  is  one  of  the  worst  forms 
of  exercise. 

When  a baby  is  out  of  doors  its  eyes  should  be  protected 
from  the  strong  glare  of  the  sun.  A white  or  bright 


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lining  for  the  carriage  is  very  trying  on  the  eyes.  Dark 
green  or  brown  are  suitable  shades. 

Flies  are  carriers  of  disease  wherever  they  are  found. 
For  this  reason  flies  should  be  banished  from  the  rooms 
occupied  by  the  baby,  and  when  out-of-doors  it  should 
be  protected  from  flies. 

The  baby’s  bowels  should  move  every  day;  four 
passages  may  be  expected  during  the  first  few  weeks, 
after  that  two  passages  a day  are  to  be  expected.  No 
baby  should  be  allowed  to  go  over  36  hours  without  a 
movement. 

Regular  habits  in  this  direction  can  be  greatly  aided 
by  the  mother  or  nurse.  From  the  time  a baby  is  four 
or  five  months  old,  training  in  controlling  the  bowels 
should  begin.  Many  babies  of  a year  old  who  have 
been  carefully  trained  can  be  trusted  to  tell  when  the 
bowels  are  going  to  move,  and  it  is  usually  a mother’s 
or  nurse’s  fault  if  a baby  at  eighteen  months  does  not 
know  enough  to  save  soiling  or  wetting  himself  during 
the  daytime. 

Points  to  be  Remembered. — The  baby’s  stomach  is  a 
very  delicate  piece  of  machinery  to  experiment  with. 
Do  not  go  to  the  neighbors  and  friends  for  advice  about 
a baby’s  food.  If  it  cannot  have  the  natural  food  con- 
sult a doctor  and  let  him  decide  what  food  should  be 
given. 

The  best  food  for  a baby  is  its  mother’s  milk.  Do 
not  feed  a baby  every  time  it  cries.  Have  regular  hours 
for  feeding  and  stick  to  them. 

Give  the  baby  water  to  drink  two  or  three  times  a 
day. 

The  cry  is  the  baby’s  language.  The  mother  or  home 
nurse  should  try  to  understand  this  language. 

Do  not  bring  the  baby  to  the  table  or  give  it  the  food 
prepared  for  the  family  if  you  want  it  to  live  and  be 
healthy. 

A baby  cannot  digest  starchy  foods  in  the  first  six 
months. 


EVERY-DAY  CARE  OF  THE  BABY 


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Make  the  changes  in  a baby^s  diet  very  gradually. 

Don’t  blame  the  teeth  for  all  the  signs  of  sickness  a 
baby  shows. 

If  a baby  is  a year  old  and  has  no  teeth  it  is  wise  to 
consult  a doctor  and  try  to  find  out  the  reason. 

The  dirty  custom  of  thrusting  a dummy”  into  the 
baby’s  mouth  and  trying  to  keep  it  exercising  its  jaws 
all  the  time,  is  one  to  be  ashamed  of.  It  proclaims  to  the 
world  the  ignorance  of  its  mother.  Besides  it  may  be 
the  cause  of  serious  throat  trouble  in  the  baby  later  on, 
even  if  it  does  not  cause  present  trouble. 

Protect  the  baby’s  eyes  from  the  bright  sunlight  when 
it  is  out  of  doors. 

Keep  flies  away  from  the  baby.  Flies  are  disease 
carries. 


REVIEW  QUESTIONS. 

1.  What  do  you  consider  the  best  of  all  foods  for  a baby?  How 
often  should  a baby  be  fed  ? 

2.  Mention  some  reasons  why  you  would  consider  regular  hours 
of  feeding  important. 

3.  Give  some  reasons  besides  hunger  that  might  account  for  a 
baby’s  cry. 

4.  What  rules  would  you  observe  in  regard  to  giving  drugs  to  a 
baby? 

5.  How  would  you  ascertain  whether  or  not  a baby  was  thriving  ? 

6.  About  what  age  should  a baby’s  first  teeth  be  expected  to 
appear  ? 

7.  Mention  some  reasons  why  the  dummy”  or  ^'comforter’' 
adversely  affects  the  baby. 

8.  How  does  a six  months’  old  baby  get  exercise  ? 

9.  How  often  should  a baby’s  bowels  move  ? 

10.  At  what  age  should  efforts  be  made  to  teach  the  baby  to  control 
the  bowel  movements  ? 


CHAPTER  XVII. 


THE  BOTTLE-FED  BABY. 

Demonstration  and  Practice  Work. — Preparation  of  modified 
milk  for  a baby.  Care  of  bottles  and  attachments.  Preparation 
of  barley  water.  Right  and  wrong  kinds  of  nursing  bottles. 

It  is  always  a calamity  when  a baby  has  to  be  deprived 
of  its  natural  food.  In  spite  of  what  advertisments 
say,  a perfect  substitute  has  never  been  found  for  moth- 
er's milk.  When  artifical  feeding  has  to  be  resorted  to 
for  the  baby  the  smallest  details  become  exceedingly 
important. 

Cow^s  milk  differs  in  several  ways  from  mother's  milk. 
Cow's  milk  contains  more  solid  matter,  is  apt  to  form 
tough  curds  in  the  baby's  stomach,  and  is  harder  to 
digest.  In  the  mother's  milk,  harmful  germs  are  not 
present. 

The  most  important  thing  in  preparing  milk  for  a 
baby  is  to  secure  milk  from  a healthy  cow,  and  be  sure 
that  it  has  been  carefully  and  cleanly  handled  from  the 
time  it  issues  from  the  cow  till  it  reaches  the  baby. 

Mothers  and  nurses  who  have  seen  one  baby  do  well  on 
one  special  kind  of  food  often  make  the  mistake  of  sug- 
gesting it  for  other  babies.  No  food  will  suit  all  babies. 
One  baby  will  die  when  fed  on  the  same  kind  of  food  on 
which  another  baby  flourished.  There  are  some  babies 
with  whom  cow's  milk,  however  carefully  handled,  acts 
as  a poison  and  some  other  food  must  be  given. 

Pasteurized  milk  is  milk  which  has  been  lieated  to  about 
167°  F.  and  kept  at  that  temperature  for  twenty  minutes. 
See  page  67. 

Sterilized  milk  is  milk  which  has  been  heated  to  boiling- 
point  (212°  F.),  and  kept  at  that  point  long  enough  to  kill 

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all  germs  which  it  may  contain.  This  milk  is  harder  for 
babies  to  digest,  and  is  less  nourishing  than  pure  raw 
milk. 

Modified  milk  is  cow^s  milk  which  has  been  altered  by 
diluting  it  with  water  and  adding  cream  and  other  sub- 
stances that  will  render  it  easier  to  digest. 

In  emergency  the  following  formula  may  be  used  to 
prepare  food  for  the  baby: 


Milk two  tablespoonfuls. 

Cream three  tablespoonfuls. 

Milk  sugar three  and  one-half  teaspoonfuls. 

Soda  solution one  tablespoonful. 


Water  enough  to  make  one-half  pint. 

The  soda  solution  is  made  by  adding  one-half  tea- 
spoonful of  baking  soda  to  one  pint  of  cold  boiled  water. 
This  solution  will  keep  indefinitely. 

It  is  better  to  prepare  enough  food  for  the  baby  for 
24  hours  each  morning,  and  keep  it  on  ice.  It  can  be 
prepared  in  a glass  jar  and  kept  tightly  covered  and  put 
in  a cool  place.  In  summer  the  baby^s  food  should 
always  be  kept  on  ice.  It  is  warmed  before  giving  to 
the  baby  by  setting  the  bottle  in  a tin  of  warm  water 
for  a few  minutes. 

To  pasteurize  the  modified  milk,  set  glass  jar  with 
the  milk  or  the  bottles  in  a bucket  of  water  over  a slow 
fire.  Heat  the  milk  to  about  167°  F.  Do  not  let  it  boil. 
(See  rules  for  using  the  pastometer,  page  68.)  The 
milk  is  then  removed  from  the  fire  and  as  soon  as  it  is 
safe  to  avoid  cracking  the  glass,  it  is  plunged  into  a 
bucket  of  cold  water,  and  when  cold  is  placed  in  the 
refrigerator. 

The  quanity  of  milk  for  each  feeding  will  vary  with 
the  age  and  size  of  the  child.  A large  plump  baby  will 
need  more  food  than  a smaller  baby  of  the  same  age. 

Right  and  Wrong  Kinds  of  Nursing  Bottles. — A nursing 
bottle  should  have  no  sharp  corners.  One  with  a rounded 
bottom  is  best.  It  should  have  the  number  of  ounces 
marked  plainly  on  the  bottle  so  that  one  can  see  at  a 


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glance  how  much  milk  the  bottle  contains.  Bottles  with 
long  rubber  or  glass  tubes  should  never  be  used  as  the 
inside  of  the  tube  cannot  be  kept  clean.  The  rubber  tips 
or  nipples  should  have  a hole  large  enough  to  drop 
rapidly,  but  not  to  run  in  a stream  when  the  bottle  is 
turned  downward. 

Bottles,  tips,  and  everything  used  about  the  baby^s 
milk  need  rigidly  careful  cleaning.  The  milk  should 
never  be  left  in  the  bottle  after  the  baby  has  finished  with 
it,  neither  should  left-over  milk  be  offered  the  second  time 
to  the  baby. 

As  soon  as  the  baby  has  finished  feeding,  the  bottle 
should  be  taken  away  and  washed.  It  is  then  put  in  a 
basin  of  cold  water  to  which  a little  baking  soda  has  been 
added  and  allowed  to  come  to  a boil  on  the  stove.  It 
remains  immersed  in  this  water  in  a covered  vessel  till  it 
is  needed. 

Tips  or  nipples  should  be  thoroughly  cleansed  after 
use,  boiled  every  day  and  kept  in  borax  water,  a half 
teaspoonful  to  a cup  of  water.  To  cleanse  the  nipples  it 
is  necessary  to  invert  them.  Just  before  using,  pour  a 
little  scalding  water  over  the  tips.  The  tips  or  nipples 
do  not  last  long  and  if  boiled  too  often  cause  trouble  when 
the  baby  is  trying  to  feed,  by  collapsing.  Be  very  sure 
that  your  own  hands  are  clean  before  you  touch  the 
rubber  nipple. 

In  many  large  cities  milk  already  prepared  for  babies 
can  be  had  at  milk  stations.  Nipples  already  sterilized 
and  wrapped  in  waxed  paper  are  furnished  with  each 
day^s  feeding.  Directions  about  how  to  care  for  the 
milk  are  given  also  in  such  cases. 

During  feeding  the  baby  should  not  be  left  alone  with 
its  bottle.  If  left  alone  it  is  likely  to  drink  too  fast,  or  too 
slowly  so  that  the  milk  cools;  to  lose  the  nipple  and  get  it 
dirty,  or  to  take  too  little,  all  of  which  can  usually  be 
])revented  if  the  mother  or  nurse  holds  the  bottle  and 
encourages  or  checks  as  occasion  requires.  Never  give 
cold  milk  to  a baby. 


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Condensed  milk  is  not  a good  food  for  the  average  baby. 
Very  often  babies  on  it  grow  fat  and  plump  but  the  flesh 
is  not  healthy  flesh,  and  babies  fed  on  condensed  milk  are 
not  likely  to  grow  strong.  It  is  sometimes  useful  as  an 
emergency  food.  When  a tin  of  condensed  milk  is 
opened,  the  milk  should  be  removed  from  the  tin  at  once 
and  put  in  a covered  glass  jar  on  ice  or  in  a cool  place. 
The  same  rigid  cleanliness  about  bottles  and  utensils 
should  be  observed  as  with  raw  milk.  It  should  be 
diluted  with  cold  boiled  water,  the  mixture  being  re- 
heated by  standing  the  bottle  in  a tin  of  warm  water 
for  a few  minutes  before  using. 

Barley  water  is  often  prescribed  to  dilute  the  baby^s 
milk,  thus  rendering  it  easier  to  digest.  The  prepared  or 
ground  barley  is  more  convenient  to  use  than  the  pearl 
barley. 

To  make  it,  cook  one  level  teaspoonful  of  barley  flour 
in  one  and  a half  cupfuls  of  hot  water  for  fifteen  minutes. 
Blend  the  barley  flour  to  a smooth  paste  with  a little  cold 
water  before  adding  it  to  the  water,  and  stir  constantly. 
This  is  used  instead  of  clear  water  to  dilute  the  milk. 

Oatmeal  water  is  made  by  pouring  a quart  of  cold  water 
over  a teacupful  of  oatmeal.  Let  it  soak  for  an  hour. 
Squeeze  the  water  and  starchy  part  through  a colander, 
and  boil  one  hour  in  a double  boiler.  This  makes  a 
thick  jelly.  One  or  two  teaspoonfuls  of  this  jelly  are 
dissolved  in  a pint  of  water  and  added  to  the  food  instead 
of  plain  water,  to  dilute  the  milk. 

Food  During  the  Second  Year. — Until  a baby  has  passed 
its  second  year  its  food  should  be  most  carefully  watched. 
By  the  end  of  the  first  year  well-cooked  oatmeal,  cream 
of  wheat,  farina,  or  rice  may  be  given  with  milk.  Soup, 
free  from  fat,  and  slightly  thickened  may  occasionally  be 
given.  Mashed  or  roasted  potato,  sago,  tapioca,  junket, 
blanc  mange,  bread  and  milk,  milk  toast,  or  a soft  boiled 
egg  may  be  gradually  added  to  its  diet,  but  milk  should 
still  be  the  chief  food  up  to  eighteen  months.  After  the 
eighteenth  month,  bread  and  gravy,  rice  pudding,  egg 
10 


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custard,  a baked  apple,  and  a small  amount  of  seedless 
fruit  may  be  given.  Meat  if  given  at  all  should  be  minced 
up  finely.  No  child  under  two  years  can  be  depended 
upon  to  chew  meat  sufficiently,  and  undigested  pieces  of 
meat  in  the  body  are  fairly  certain  to  ferment  and  cause 
trouble.  A great  deal  of  bowel  trouble  in  children  of 
this  age  is  due  to  giving  them  unmashed  potatoes,  meat, 
and  other  food  which  is  swallowed  in  chunks. 

Foods  Forbidden  to  Young  Children. — The  following 
articles  are  said  to  be  particularly  hard  for  children  to 
digest  and  should  not  be  allowed  them  under  four  years 
of  age: 

Fried  foods  of  all  kinds,  pork,  pickles,  salads,  mustard 
and  pepper,  liver,  kidneys,  tomatoes,  corn,  cabbage, 
beets  and  the  coarser  vegetables,  confectionery,  fancy 
cakes  and  pastry,  pancakes,  cheese,  rich  soups,  nuts, 
gravy,  fruits  with  large  seeds  such  as  grapes,  the  skin  of 
all  poultry,  fruits  and  vegetables,  dried  or  unripe  fruits, 
and  canned  foods  of  all  kinds. 

This  list  and  the  list  of  rules  that  follow  are  taken 
from  Practical  Dietetics,  by  W.  Gilman  Thompson,  M.  D. 

General  Rules  for  Feeding  Young  Children. 

1.  Allow  time  for  meals. 

2.  See  that  the  food  is  thoroughly  masticated. 

3.  Do  not  allow  nibbling  between  meals. 

4.  Do  not  tempt  the  child  with  the  sight  of  rich  and 
indigestible  food. 

5.  Do  not  force  the  child  to  eat  against  its  will  but 
examine  the  mouth,  which  may  be  sore  from  erupting 
teeth;  and  examine  the  food  which  may  not  be  properly 
cooked  or  flavored. 

6.  In  acute  illness  reduce  and  dilute  the  food  at  once. 

7.  In  very  hot  weather  give  about  one-fourth  or  one- 
third  less  food  and  offer  more  water. 

What  kills  the  babies?  ^^In  each  100  deaths  among 
children  under  two  years  of  age  thirty-seven  are  caused 
l)y  diseases  of  the  digestive  system;  twenty-three  by 
impure  air;  nineteen  by  defects  and  accidents  at  birth; 


THE  BOTTLE-FED  BABY 


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nine  by  acute  contagious  diseases;  3 by  disease  of  the 
nervous  system;  two  by  tuberculosis;  two  by  violence; 
while  a variety  of  ailments  contribute  to  make  up  the 
balance’’  says  the  Chicago  Department  of  Health. 

Summer  Care  of  Sick  Babies.^ — ^^3929  babies  died  in 
New  York  City  last  summer  from  diarrheal  diseases. 
Most  of  them  died  because  they  were  given  improper 
food.  They  could  have  been  saved  if  they  had  been 
taken  to  the  doctor  at  the  beginning  of  their  illness, 
and  had  been  properly  fed. 

^Hn  hot  weather,  two  or  three  loose  movements  a day, 
even  though  the  baby  seems  to  be  well,  may  indicate  the 
beginning  of  serious  illness;  a doctor  should  see  the  baby 
at  once.  Remember  that  it  is  far  easier  to  keep  the 
baby  well  than  to  cure  it  when  sick. 

^^The  baby  is  sick  when  it  vomits  or  has  diarrhea,  and 
it  is  seriously  sick  when  it  has  several  loose  green  pas- 
sages a day  containing  mucus  and  curds.  Improper 
food  is  the  cause  of  such  illness;  therefore  stop  all  food, 
give  cool  boiled  water  and  take  the  baby  to  a doctor  at 
once.  In  summer  it  is  dangerous  to  wait. 

Breast-fed  babies  often  vomit  or  have  diarrhea  because 
the  mother  is  sick  or  tired  out  and  her  milk  is  poor. 

^Hmproper  food,  irregular  meals,  lack  of  rest  and 
sleep,  too  frequent  or  too  prolonged  nursing,  weaken 
the  mother  and  injure  her  milk.  These  causes  act  es- 
pecially in  hot  weather. 

Nursing  mothers  should  therefore  keep  themselves 
well  and  their  milk  in  good  condition,  by  eating  at 
regular  hours,  three  plain,  well-cooked  meals  a day,  and 
they  should  drink  water  between  meals.  They  should 
nurse  the  baby  at  regular  hours.  They  should  keep 
their  bowels  regular;  constipation  in  a nursing  mother 
often  causes  colic  in  her  baby.  Large  quantities  of  tea, 
coffee  and  beer  do  not  improve  the  quality  of  a mother’s 
milk  and  may  be  injurious  to  her  baby.  So  long  as  the 
mother  keeps  well  the  baby  will  be  well. 

instructions  issued  by  the  New  York  Department  of  Health. 


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the  mother  is  ill  or  ^run  down’  or  the  baby  has 
diarrhea  and  vomiting,  she  should  consult  a doctor  at 
once  and  before  giving  the  baby  other  foods  or  bottle- 
feeding.  The  quality  of  the  mother^s  milk  may  be  im- 
proved by  improving  her  health. 

Bottle-fed  babies  often  have  diarrhea  and  vomiting 
because  the  milk  used  is  bad  and  old,  or  the  feedings  are 
not  properly  prepared  or  properly  kept,  or  the  nursing- 
bottles  and  nipples  are  dirty. 

Bottle-fed  babies  must  be  given  only  good  milk  which 
is  kept  constantly  covered  and  on  ice.  Use  milk 
furnished  by  the  milk  depots  or  diet  kitchens;  if  the 
milk  stations  are  not  convenient,  get  good  bottled  milk 
which  is  delivered  every  morning.  If  the  milk  cannot 
be  kept  properly  cooled,  it  should  be  boiled  as  soon  as 
received. 

Prepare  the  feedings  for  the  baby  exactly  as  the 
doctor  directs.  Feed  the  baby  at  regular  hours.  Each 
feeding  should  be  heated  to  a proper  temperature  in 
the  nursing-bottle  before  it  is  given  to  the  baby.  Taste 
a spoonful  of  the  milk  immediately  before  giving  it  to 
the  baby  to  be  sure  that  it  has  not  soured.  If  the  milk 
is  not  sweet,  do  not  give  it  to  the  baby. 

^^As  soon  as  the  bottle  used  by  the  baby  is  empty,  it 
should  be  thoroughly  washed  with  cold  water,  then 
cleansed  with  borax  and  hot  water  (teaspoonful  of 
borax  to  a pint  of  water).  The  empty  bottles  should 
be  put  upside  down  on  a shelf.  The  bottles  should  be 
boiled  just  before  filling  for  the  next  feeding.  The 
nipple  should  be  thoroughly  washed  after  each  nursing 
with  hot  water,  and  when  not  in  use  should  soak  in  borax 
water  in  a covered  glass;  the  nipple  must  be  rinsed  in 
boiling  water  just  before  the  baby  uses  it. 

Clothing. — During  the  very  hot  days,  or  if  the  baby 
has  fever,  remove  nearly  all  the  clothing.  A muslin 
slip  or  gauze  shirt  is  enough.  A baby  with  fever  will 
not  catch  cold. 

Bathing. — A baby  should  have  one  tub  bath  every 


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day;  on  very  warm  days  from  two  to  four  general  spong- 
ings  with  cool  water.  If  the  baby  has  fever  sponge  it 
with  cool  water  every  two  or  three  hours  and  place  cool, 
wet  cloths  on  its  head. 

Fresh  Air, — Babies,  sick  or  well,  must  have  fresh  air. 
Keep  the  baby  in  the  largest,  coolest  room  in  the  house 
or  apartment.  Keep  as  little  fire  as  possible.  Keep 
the  rooms  free  from  garbage,  soiled  clothes  and  rubbish. 
Leave  the  windows  open  day  and  night.  Avoid  the  sun 
on  hot  days.  Select  the  shady  side  of  the  street  and  the 
shade  of  the  parks,  recreation  piers  and  roofs. 

Sleep  and  Quiet. — Keep  the  baby  quiet.  Let  it  sleep 
alone  and  let  it  sleep  as  much  as  possible.  Lay  it  on  a 
firm  bed,  not  on  feather  pillows.  Keep  the  baby  and 
bedclothes  clean.  Change  the  diapers  and  bedclothes 
as  soon  as  soiled,  and  sponge  the  baby  with  a soft  cloth 
and  cool  water.  If  this  is  done  the  baby  will  not  be 
so  restless  and  will  sleep  better.  Do  not  give  ^ soothing 
syrup  ’ to  make  the  baby  quiet,  and  do  not  let  the  baby 
hang  on  the  nipple  or  suck  a ^baby  comforter.^ 

Diapers. — Diapers  should  be  carefully  washed  as  soon 
as  they  become  soiled,  and  then  dried  in  the  open  air. 
Do  not  use  a soiled  diaper  a second  time  before  wash- 
ing it.^’ 

Points  to  be  Remembered. — The  bottle-fed  baby  is 
always  in  danger  of  being  killed  through  the  careless- 
ness of  its  mother  or  nurse. 

Cow’s  milk  needs  to  be  modified  or  changed  to  make 
it  a fit  food  for  the  baby. 

It  is  very  important  to  get  clean  milk  for  the  baby. 

Milk  which  has  been  carelessly  handled  contains  disease 
germs  which  threaten  the  life  of  the  baby. 

No  kind  of  food  will  suit  all  babies.  Do  not  give  advice 
to  other  people  as.  to  what  food  they  should  give  their 
babies.  Your  well-meant  advice  may  lead  to  the  babies 
death. 

You  cannot  be  too  careful  about  the  cleanliness  of 
nursing  bottles  and  tips. 


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Always  wash  and  boil  the  bottle  after  using. 

Never  offer  left-over  or  cold  milk  to  a baby. 

Do  not  leave  the  nursing  bottle  in  the  cradle  or  crib 
after  the  baby  has  finished  feeding  till  it  smells  sour. 
Wash  it  at  once. 

Stay  with  the  baby  and  hold  the  bottle  while  he  is 
feeding. 

Condensed  milk  is  not  a good  food  for  the  average 
baby. 

Do  not  give  a child  food  which  needs  chewing  till 
it  has  sense  enough  to  chew  it  thoroughly. 

A great  deal  of  bowel  trouble  among  children  is  caused 
by  giving  them  meat,  corn,  potatoes  in  chunks,  and  such 
foods  that  are  not  chewed  and  therefore  can  not  be 
digested  properly. 

Do  not  tempt  a child  with  rich  or  unwholesome  food 
which  it  is  not  allowed  to  have. 

REVIEW  QUESTIONS. 

1.  Tell  why  it  is  important  to  secure  perfectly  clean  cow’s  milk 
for  baby. 

2.  What  is  modified  milk?  Give  one  formula  for  preparing  it. 

3.  Explain  what  you  would  consider  the  right  kind  of  a nursing- 
bottle  and  attachments. 

4.  How  would  you  care  for  the  bottle  and  attachments  before 
and  after  using  ? 

5.  What  other  precautions  would  you  observe  in  the  artificial 
feeding  of  a baby  ? 

6.  Why  is  barley  water  sometimes  mixed  with  milk  for  a baby  ? 

7.  Describe  what  you  would  consider  suitable  foods  for  a baby 
during  the  second  year. 

8.  What  precautions  should  be  observed  regarding  the  meals  of 
all  young  children  after  they  are  given  solid  food? 

9.  Mention  several  different  kinds  of  food  which  you  would  not 
give  to  a child  under  four  years  of  age. 

10.  Outline  the  routine  care  you  would  give  a six  months  old  baby 
during  the  summer. 


CHAPTER  XVIII. 


HOUSEHOLD  DISINFECTANTS,  AND  HOW  TO  USE 
THEM. 

Demonstration  and  Practice  Work. — Making  and  labelling  of 
disinfectant  solutions. 

In  every  home  that  is  kept  in  a sanitary,  healthy 
condition  some  household  disinfectants  are  needed. 
The  term  disinfectant  may  not  be  used  but  the  custom 
of  making  use  of  some  disinfectants  is  general  in  every 
well  kept  home. 

A disinfectant  is  a substance  that  kills  all  germs  that 
have  power  to  infect  or  cause  disease.  We  learned  in  a 
previous  lesson  something  about  germs  and  will  re- 
member that  there  are  good  and  bad  germs.  All  germs 
are  not  infectious,  or  disease,  germs.  Some  infectious 
germs  are  much  harder  to  kill  than  others. 

An  antiseptic  is  a substance  that  prevents  the  growth 
of  germs  but  does  not  necessarily  kill  them. 

Natural  Disinfectants. — Without  knowing  exactly  why 
she  does  so,  except  that  ^4t  is  healthier’^  the  housewife 
puts  bedding,  clothing,  etc.,  out  to  sun  and  air  them. 
Experiments  with  different  kinds  of  germs  have  shown 
that  exposure  to  bright  sunshine  for  a few  hours  is  one 
of  the  best  ways  of  killing  a great  many  kinds  of  germs. 
Letting  the  sunlight  flood  the  room  helps  to  check  the 
growth  of  germs  of  all  kinds. 

Dampness  favors  the  growth  of  germs  and  therefore, 
sunlight  by  drying  out  a room,  helps  to  keep  it  free  from 
infectious  germs. 

Soap  and  water  also  are  important  aids  in  this  work. 
The  housewife  who  uses  soap  and  water  liberally  in  every 
part  of  her  home,  admits  the  sunshine  freely,  and  prevents 
dampness,  has  done  much  to  keep  it  healthy. 

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Heat, — Boiling  is  one  of  the  easiest  and  best  of  all 
ways  of  killing  disease  germs,  and  wherever  boiling  can 
be  used  without  damage  to  the  article,  it  should  be  used 
in  preference  to  all  other  methods.  Fire  is  the  greatest 
of  all  purifiers  and  should  be  used  to  dispose  of  infected 
material  in  the  form  of  soiled  dressings  from  wounds, 
and  useless  dangerous  materials.  All  such  materials 
should  be  wrapped  in  newspapers  and  promptly  burned — 
never  left  to  lie  around  carelessly. 

Boiling  of  all  basins,  instruments  used  about  wounds, 
sputum  cups,  dishes,  glasses,  and  general  sick-room  uten- 
sils, is  the  easiest  way  of  disinfecting  them  and  making 
them  safe  for  well  people  to  use. 

Infected  clothing  which  must  be  washed,  before 
boiling,  should  be  soaked  in  a disinfectant  solution  long 
enough  to  really  disinfect.  All  disinfectant  solutions 
require  time  to  do  the  work.  Momentary  contact  with 
such  a solution  is  never  to  be  depended  on  for  safety. 
Most  disinfectants  are  more  powerful  if  used  hot. 

A solution  that  is  highly  recommended  for  disinfecting 
washable  clothing  contains  the  following: 

Carbolic  acid  three  parts;  common  soft  soap  one  and 
one-half  parts;  water  100  parts.  Common  laundry  soap 
is  first  dissolved  in  water,  the  carbolic  acid  is  added,  and 
the  mixture  is  vigorously  stirred.  Commercial  carbolic 
acid  may  be  used  which  is  less  expensive  than  the  purified 
product.  If  this  solution  is  used  hot,  infected  clothing 
that  is  soaked  in  it  for  one  hour  may  be  considered  safe 
and  may  be  mingled  with  other  clothing. 

When  removing  sheets  or  bed  linen  from  a patient  with 
a communicable  disease,  first  wring  a sheet  out  of  the 
disinfectant  solution  and  spread  it  on  the  floor  to  re- 
ceive gowns,  towels,  pillow  covers,  etc.,  as  they  are  re- 
moved until  thorough  disinfection  of  each  article  can  be 
attended  to. 

Woolen  clothing  that  should  be  washed  should  not  be 
allowed  in  the  room  with  a patient  who  has  a com- 
municable disease.  It  often  happens,  however,  that  the 


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suit  the  person  has  worn  while  the  disease  was  develop- 
ing must  remain  there.  All  such  clothing  should  be 
thoroughly  fumigated  and  afterwards  well  aired. 

Fumigation  is  the  exposure  of  articles  to  a gaseous 
disinfectant.  Formaldehyde  and  sulphur  are  the  two 
drugs  which  are  commonly  used  for  this  purpose,  but 
formaldehyde  has  within  recent  years  almost  entirely 
displaced  the  old-fashioned  sulphur  fumigation. 

Several  things  should  be  borne  in  mind  in  regard  to 
formaldehyde: 

1.  It  does  not  disinfect  beneath  the  surface  of  an 
article. 

2.  It  is  necessary  in  order  to  get  the  best  results  to 
obtain  a large  volume  of  gas  in  a short  time. 

3.  It  has  no  injurious  effect  on  fabrics  or  colors. 

4.  It  should  never  be  used  in  a room  in  which  the 
temperature  is  below  50°  F. 

5.  A higher  degree  of  heat  helps  the  disinfecting  power 
of  the  gas. 

6.  A bucket  of  boiling  water  should  be  placed  in  the 
room  just  before  disinfection  as  a certain  amount  of 
moisture  helps  to  thorough  disinfection. 

7.  It  does  not  kill  insects,  and  has  practically  no  effect 
on  bed-bugs,  roaches,  and  such  vermin. 

Methods  of  using  formaldehyde  vary.  One  of  the 
simplest  ways  is  by  the  sheet  method. 

To  fumigate  a room,  first  close  all  windows,  fireplaces, 
all  cracks  and  ventilators.  The  cracks  should  be  stopped 
with  cotton  batting.  A rope  is  strung  across  the  room. 
All  bureau  drawers,  trunks,  etc.,  are  opened.  Mattresses 
are  thrown  over  the  foot  of  the  bed  so  as  to  expose  as 
much  surface  as  possible.  Rugs  and  other  articles  are 
arranged  in  the  same  way.  The  gas  cannot  be  depended 
upon  to  disinfect  the  interior  of  a mattress  or  quilt — • 
only  the  surface.  Have  a dry  sheet  ready  in  a basin  and 
the  formaldehyde,  which  is  purchased  in  a 40  per  cent, 
solution,  ready  to  pour  over  it.  Bring  in  then  the  tub  or 
bucket  of  steaming  boiling  water.  Pour  the  formalde- 


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hyde  over  the  sheet  in  the  basin,  throw  the  sheet  over 
the  line  prepared  for  it,  and  beat  a hasty  retreat.  Close 
the  doors  and  cracks  around  them  with  cotton  batting 
or  by  sealing  with  paper  over  the  cracks. 

Quantity. — One  pint  of  formaldehyde  for  every  1000 
cubic  feet  of  space  should  be  used. 

The  disinfecting  power  of  formaldehyde  gas  is  increased 
by  combining  it  with  another  drug  known  as  potas- 
sium permanganate  in  the  proportion  of  3 1 / 2 ounces  to 
1 pint  of  formaldehyde.  The  potassium  crystals  are  put 
into  a large  tin  vessel  or  pail  which  is  set  inside  a wooden 
or  pulp  bucket  and  the  formaldehyde  is  poured  over 
them  after  the  room  has  been  prepared. 

The  room  should  remain  closed  for  at  least  twelve 
hours  and  afterward  be  thoroughly  sunned  and  aired. 
Liquid  ammonia  sprinkled  about  the  room  after  it  is 
opened  helps  to  get  rid  of  the  lingering  fumes  of  the  drug. 

When  a suit  of  clothes  or  small  articles  require  to  be 
fumigated,  a large  box  rendered  airtight  by  papering  it 
inside  may  be  used,  or  a hogshead  or  galvanized  iron  can. 
A slat  shelf  with  iron  or  wire  hooks  that  fasten  over  the 
top  may  be  used,  the  whole  being  tightly  covered.  This 
contrivance  confines  the  fumes  in  a small  space  and  a 
twenty-four  hour  exposure  will  render  the  contents  safe. 
Care  should  be  used  to  expose  all  possible  surfaces  of  the 
garments. 

Sulphur  gas  is  a good  surface  disinfectant.  It  also 
requires  moisture  in  the  room  to  do  its  best  work.  It 
injures  metal  and  cotton  and  linen  materials.  It  has 
the  advantage  of  cheapness  and  can  usually  be  readily 
obtained. 

Quantity. — Authorities  on  disinfection  recommend 
the  use  of  five  pounds  of  sulphur  to  every  1000  cubic  feet 
of  space. 

The  room  should  be  kept  closed  at  least  sixteen  hours. 
In  arranging  the  sulphur,  place  it  in  three  or  four  vessels, 
rather  than  all  in  one  thus  creating  a stronger  volume  of 
gas.  Old  tomato  cans  are  often  used  to  hold  the  sulphur. 


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These  should  be  placed  in  tin  dishes  of  water,  which  are 
raised  from  the  floor  by  bricks,  as  a precaution  against 
fire.  Alcohol  is  poured  over  the  sulphur  powder,  and  a 
match  applied  to  it  sets  the  gas  free.  The  same  care 
should  be  used  in  exposing  surfaces  as  in  formaldehyde 
fumigation. 

Chloride  of  lime  is  said  to  be  one  of  the  strongest  dis- 
infectants known.  It  is  used  to  disinfect  excreta,  sinks, 
water-closets,  and  drains,  but  should  never  be  used  to 
disinfect  clothing  as  it  ruins  the  fabric.  Chloride  of  lime 
is  used  in  a 4 per  cent,  solution  which  requires  approxi- 
mately six  ounces  dissolved  in  a gallon  of  water. 

The  custom  of  setting  dishes  of  chloride  of  lime 
moistened  with  water  in  a sick  room  in  the  hope  that  the 
fumes  will  disinfect  the  air,  or  the  room,  is  a vain  delusion 
that  does  not  spell  safety.  It  may  help  to  neutralize 
a bad  odor  by  substituting  a different  sort  of  odor,  but 
such  methods  do  not  disinfect.  They  give  a false  sense 
of  safety.  Hiding  a bad  smell  by  a powerful  drug  is  not 
remedying  the  evil. 

Milk  of  lime  is  the  least  expensive  of  all  disinfectants. 
It  is  made  by  adding  one  pint  of  water  to  two  pounds  of 
dry  quick-lime.  This  produces  slaked  lime.  After  bub- 
bling ceases  add  four  times  as  much  water  as  the  volume 
of  slaked  lime.  Solutions  should  be  made  at  least  once 
every  two  days.  Lime  which  has  been  exposed  to  the 
air  loses  its  strength  soon  and  should  not  be  used. 

To  disinfect  the  waste  from  the  human  body  the  milk 
of  lime  should  be  used  in  quantity  equal  to  the  amount 
of  excreta  to  be  disinfected,  thoroughly  mixed,  and 
allowed  to  stand  two  hours.  This  solution  is  useful  also 
to  disinfect  sinks,  drains,  or  to  whitewash  exposed  sur- 
faces. 

Bichloride  of  mercury  or  corrosive  sublimate  solution 
is  one  of  the  most  powerful  of  disinfectants,  but  there 
are  many  limitations  to  its  use.  It  corrodes  metal  of  all 
kinds  and  should  not  be  used  to  disinfect  sinks,  plumbing 
of  any  kind,  or  metallic  instruments.  It  is  sometimes 


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used  to  disinfect  washable  clothing.  When  so  used  it  is 
made  in  a solution  of  one  1:1000  or  1 part  of  the  drug  to 
1000  parts  of  water.  It  should  be  used  hot  whenever 
possible,  and  the  clothing  allowed  to  soak  at  least  one 
hour.  It  is  not  a safe  disinfectant  for  sputum  or  excreta 
of  any  kind. 

Bichloride  of  mercury  when  used  in  the  home  is  best 
made  from  the  tablets  specially  prepared  for  that  purpose. 
These  may  be  procured  from  any  druggist.  Each  tablet 
contains  enough  of  the  drug  to  make  a 1-1000  solution 
when  dissolved  in  a pint  of  water.  This  solution  if  used 
too  strong  may  produce  a distressing  burn  which  will  be 
slow  in  healing.  All  disinfectant  solutions  should  be 
carefully  labeled  and  kept  where  children  cannot  reach 
them. 

Caution. — The  solution  closely  resembles  water  and 
mistakes  are  easily  made  and  usually  fatal. 

The  poisonous  nature  of  all  such  drugs  should  be 
impressed  on  all  who  have  responsibility  in  the  sick- 
room. Many  deaths  have  been  caused  by  disinfectants 
being  taken  for  something  else  and  given  to  the  sick. 

Carbolic  acid  solution  is  used  for  disinfectant  purposes  in 
a solution  of  from  3 to  5 per  cent.  To  make  a gallon  of  a 
5 per  cent,  solution  of  a solution  in  which  one  part  of  the 
drug  is  used  to  twenty  parts  of  water,  dissolve  seven  fluid 
ounces  (an  ounce  is  two  tablespoonfuls)  of  carbolic  acid 
in  a gallon  of  boiling  water  and  shake  till  all  the  globules 
of  acid  are  dissolved.  Extensive  burns  have  been  caused 
by  the  neglect  to  have  the  acid  thoroughly  dissolved. 
Should  a burn  from  carbolic  acid  occur,  apply  alcohol 
to  the  part  at  once.  Cider  vinegar  is  also  an  antidote. 

Boracic  {or  boric)  acid  is  a mild  unirritating  solution 
much  used  in  eye  treatments,  and  in  surgical  work  in 
general.  It  is  generally  used  as  strong  as  it  can  be  made. 
A solution  in  which  the  water  cannot  dissolve  any  more 
of  the  drug  is  called  a saturated  solution. 

Salt  solution  is  made  by  dissolving  one  teaspoonful 
of  clean  table  salt  in  a pint  of  water.  Because  of  the 


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ease  with  which  this  solution  is  obtained  it  is  one  of  the 
most  valuable  for  home  use.  It  should  not  be  used  to 
disinfect  clothing  or  utensils,  but  in  dressing  wounds 
and  for  irrigating  any  part  it  has  a wide  field  of  use- 
fulness. 

Peroxide  of  hydrogen  is  one  of  the  safest  of  all  disinfec- 
tants for  household  purposes.  It  is  powerful  in  its  action 
on  disease  germs,  and  yet  practically  harmless  if  taken 
internally.  Care  should  be  exercised  to  secure  a pure 
peroxide  of  hydrogen  for  use  in  the  sick-room  and  for  the 
personal  toilet.  There  are  different  grades  or  qualities 
of  this  article  and  an  adulterated  commercial  product 
sold  for  bleaching  purposes  to  mills  and  factories  is 
sometimes  sold  as  a substitute  for  the  medical  article. 

Peroxide  of  hydrogen  is  much  used  as  a mouth  wash 
in  measles,  typhoid  fever,  pneumonia  etc.,  when  fever 
is  present.  A teaspoonful  to  a quarter  glass  of  water 
makes  a good  mouth  wash  or  gargle.  In  small  wounds 
such  'as  cuts,  or  scratches,  it  may  be  used  to  prevent 
infection  and  promote  healing.  Its  uses  as  a disinfectant 
are  mainly  about  wounds,  or  to  disinfect  the  mouth  and 
throat.  It  should  not  be  used  to  disinfect  sick-room 
utensils. 

Points  to  be  Remembered. — Of  all  means  of  keeping- 
well  the  best  is  to  keep  clean. 

Nature  provides  in  abundance  two  powerful  disinfec- 
tants, sunlight  and  oxygen. 

Dampness  and  dirt  favor  the  growth  of  germs. 

Mattresses,  beds,  and  bedding  should  be  sunned  and 
aired  frequently. 

Boiling  even  for  a few  minutes  will  kill  most  of  the 
disease  germs,  such  as  typhoid  fever,  diphtheria,  tuber- 
culosis, pneumonia. 

Boiling  for  ten  minutes  will  render  drinking  water 
safe. 

Most  disinfectants  are  more  powerful  if  used  hot. 

Fumigation  can  only  be  depended  on  to  disinfect 
exposed  surfaces.  Gaseous  disinfectants  are  more 


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effective  if  used  in  a warm  room  with  moisture  in  the 
air. 

Freezing  cannot  be  depended  on  to  kill  germs. 

Infected  ice  has  caused  some  very  serious  typhoid 
fever  epidemics.  Be  sure  that  all  disinfectant  solutions 
are  labeled  and  kept  out  of  the  reach  of  children. 

Always  allow  a disinfectant  plenty  of  time  to  do  its 
work. 

In  making  a carbolic  acid  solution  be  sure  that  all 
the  globules  of  acid  are  dissolved. 

Remember  that  alcohol  is  an  antidote  for  carbolic  acid 
burns.  Cider  vinegar  is  also  used  as  an  antidote. 

Bichloride  of  mercury  should  never  be  used  to  disin- 
fect metallic  substances  of  any  kind. 

REVIEW  QUESTIONS. 

1.  What  is  a disinfectant?  Name  four  methods  of  disinfection 
that  may  be  used  in  a home. 

2.  What  effect  does  bright  sunshine  have  on  disease  germs  ? 

3.  What  precautions  should  be  observed  in  the  handling  of  in- 
fected clothing  which  has  been  removed  from  the  patient  or 
bed? 

4.  Name  two  drugs  that  are  used  for  fumigation  and  state  how 
much  of  each  drug  is  required. 

5.  How  would  you  disinfect  a suit  of  men’s  clothes  or  a woolen, 
or  silk  dress  ? 

6.  How  should  a room  and  contents  be  prepared  for  fumigation  ? 

7.  What  substances  may  be  properly  disinfected  with  chloride 
of  lime  ? What  effect  would  this  drug  have  on  cotton  ? 

8.  What  precautions  should  be  observed  in  making  a carbolic 
acid  solution  ? What  is  the  best  antidote  for  a burn  caused 
by  carbolic  acid  ? 

9.  How  would  you  prepare  a quart  of  salt  solution  ? 

10.  How  would  you  disinfect  the  following  articles;  infected  sheets; 
sputum  from  a tuberculosis  patient;  an  enameled  basin;  a 
kitchen  sink;  a mattress? 


CHAPTER  XIX. 


COMMUNICABLE  DISEASES  IN  THE  HOME. 

Demonstration  and  Practice  Work. — Preparation  of  room  for 
fumigation,  with  dresser  drawers  opened,  and  articles  arranged 
so  as  to  expose  all  possible  surfaces. 

When  one  of  the  acute  communicable  or  catching^’ 
diseases  enters  the  home,  the  welfare  of  the  members  of 
the  family  who  are  not  sick  must  be  considered,  in  com- 
mon with  the  sick  one.  Every  possible  precaution  must 
be  used  to  prevent  the  disease  spreading. 

Isolation  of  the  sick  one  is  the  first  step.  This  requires 
first  of  all  that  the  patient  have  a room  as  far  away  from 
the  rest  of  the  family  as  possible  and  that  he  have  a 
nurse  to  himself — someone  who  assumes  the  respon- 
sibility for  his  care  entirely.  This  person  must  not  be 
responsible  for  any  other  duties  of  the  house  except  the 
care  of  the  patient,  however  mild  the  case  may  be.  If 
in  the  city,  the  Board  of  Health  usually  enforces  more  or 
less  rigid  quarantine  rules  as  to  communication  with 
those  who  live  and  work  in  the  outside  world,  but  with 
all  these  safeguards  and  precautions  much  must  be  left 
to  the  good  judgment  and  good  conscience  of  the  home 
nurse.  In  the  country,  supervision  by  health  authorities 
is  less  strict,  unless  the  disease  is  especially  virulent. 

The  Room. — Usually  the  doctor  will  decide  about  the 
room.  In  measles  and  diphtheria  it  is  often  best  to  leave 
the  patient  in  the  room  in  which  he  was  taken  sick, 
rather  than  infect  another  room,  since  the  time  of  these 
illnesses  is  comparatively  short.  In  cases  of  scarlet  fever 
or  typhoid  fever  the  illness  may  be  expected  to  last  for 
weeks,  and  the  change  to  the  most  suitable  room  obtain- 
able is  very  desirable.  The  room  should  be  one  which 

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the  family  does  not  need  to  use  at  all,  and  it  should  have 
good  light  and  ventilation.  Very  often  the  sitting  room 
or  parlor  is  more  suitable  than  a bed-room  and  more  easily 
given  up  to  the  use  of  the  sick.  All  unnecessary  articles 
should  be  removed  including  draperies,  rugs,  bric-a-brac, 
pictures,  etc. 

Isolation. — When  the  patient  has  been  moved,  the 
room  just  vacated  should  be  thoroughly  fumigated, 
cleaned,  and  aired,  before  using  it.  For  directions  for 
fumigating  see  page  153. 

The  next  step  in  the  isolation  process  is  for  the  home 
nurse  to  provide  herself  with  utensils  for  the  sanitary  care 
of  the  room  and  patient.  The  broom  used  in  the  sick- 
room should  not  be  used  elsewhere  in  the  house.  A 
separate  bucket,  floor  cloth  or  mop,  dust  cloth,  hand 
basin,  supply  of  old  newspapers,  and  a tub  or  large  bucket 
for  disinfecting  will  be  needed.  Also  an  old  sheet  should 
be  in  readiness  to  be  wet  with  the  disinfectant  to  receive 
the  sheets  and  clothing  when  they  are  changed,  till  they 
can  be  disinfected. 

The  custom  of  keeping  a sheet  wet  with  a disinfectant 
hanging  before  the  door  is  an  old-fashioned  custom  which 
many  of  the  best  modern  authorities  do  not  recommend. 
It  is  doubtful  if  it  ever  did  any  real  good.  It  takes  for 
granted  that  infection  is  commonly  communicated  by 
means  of  the  air,  which  theory  is  no  longer  accepted  at 
it  once  was. 

Contact  infection  is  the  greatest  danger  in  all  such  cases. 
It  has  been  proven  that  infection  is  much  more  likely 
to  l)e  carried  by  the  hands,  by  utensils  which  have  come 
in  contact  with  the  patient,  and  by  the  clothing  of  the 
nurse  or  attendant  than  by  means  of  air. 

The  following  rules  are  enforced  in  one  of  the  newest 
contagious  disease  hospitals  and  are  equally  applicable 
to  the  care  of  the  patient  at  home: 

“To  Avoid  Taking  and  Carrying  Infection. — Keep  fin- 
gers, pencils,  pins,  labels,  and  everything  out  of  the 
mouth;  keep  and  use  your  own  drinking  glass;  do  not 


COMMUNICABLE  DISEASES  IN  THE  HOME  161 


kiss  a patient;  wash  hands  often  and  always  before  eat- 
ing. Keep  out  of  doors  as  much  as  possible,  and  always 
sleep  with  the  windows  open;  do  not  touch  face  or  head 
after  handling  a patient  until  after  hands  are  washed. 

Do  not  allow  patient  to  cough  or  sneeze  in  your  face; 
do  not  allow  patient  to  touch  your  face;  do  not  eat 
anything  the  patient  may  wish  to  give  you.  If  taking  a 
drink  or  lunch,  be  sure  and  use  the  nurses^  dishes;  put  on 
gown  or  change  uniform  when  going  into  the  ward;  on 
leaving  ward  always  wash  hands.  Always  remember 
that  infectious  diseases  are  taken  and  carried  by  contact 
and  not  by  air  infection. 

General  Precautions. — Soap  and  water  applied  to  the 
hands  and  utensils  freely  and  frequently  is  a thousand  fold 
greater  safeguard  than  a wet  sheet  before  the  door. 

The  patient^s  dishes,  glasses,  etc.,  should  not  be  returned 
to  the  kitchen  till  they  have  been  thoroughly  disinfected 
either  by  boiling  or  by  chemicals.  The  tray  used  for 
either  nurse  or  patient  can  be  covered  with  a paper  napkin 
which  can  be  burned  after  use.  Usually  it  is  better  to 
keep  a set  of  dishes  for  the  patient  in  the  room,  and  trans- 
fer the  food  to  them. 

Use  the  old  newspapers  to  wrap  garbage  or  trash  in  and 
put  promptly  into  the  fire. 

Wipe  up  the  bare  floors  daily,  using  a disinfectant  in 
the  water.  This  should  be  done  as  soon.as  possible  after 
the  patient^s  clothing  is  changed  and  the  bed  made.  A 
wet  floor  cloth  over  the  broom  is  preferable  to  a mop. 
See  Fig.  3,  page  23. 

Before  removing  any  clothing  frora  the  patient  or  bed 
have  spread  out  a sheet  wet  with  disinfectant,  to  drop 
them  into  until  they  can  be  disinfected. 

The  hair  has  been  found  to  be  effective  in  spreading 
disease.  If  obliged  to  leave  the  sick-room  to  go  to  an- 
other room  the  nurse  should  cover  it  with  a cloth  wrung 
out  of  water  in  which  some  of  the  disinfectant  solution 
was  used.  After  the  illness  is  over  the  hair  should  be 
thoroughly  washed.  Tar  soap  is  recommended  for  this 
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purpose,  or  a thorough  washing  with  soap  followed  by 
a rub  with  alcohol. 

The  germs  of  disease  are  found  in  the  discharges  from 
the  bowels,  in  the  urine,  in  vomited  matter,  and  in 
expectoration. 

In  diphtheria,  whooping  cough,  and  influenza,  the  dis- 
charges from  the  throat  and  nose  contain  the  infectious 
matter. 

In  scarlet  fever,  measles,  and  chicken-pox,  the  disease 
is  believed  to  be  communicated  by  particles  of  skin  that 
peel  off,  and  also  through  the  discharges  from  the  mouth 
and  nose. 

Infection  maj^  take  place  through  actual  contact  with 
one  who  has  the  disease,  through  books,  clothing,  food, 
toys,  etc.  Pet  animals  if  allowed  to  enter  the  sick-room 
may  easily  carry  the  disease  to  others.  Flies  are  danger- 
ous visitors  to  allow,  owing  to  their  habit  of  carrying 
germs  and  depositing  them  wherever  they  happen  to 
light.  Toys,  dolls,  picture  books,  used  during  sick- 
ness or  convalescence  by  a child,  should  be  promptly 
burned. 

Many  cases  of  contagious  disease  have  been  traced  to 
toys  which  were  thought  too  valuable  to  destroy,  but 
which  communicated  the  disease  to  neighbors’  children 
months  afterward. 

The  doctor  usually  directs  about  how  disinfection  is 
to  be  accomplished.  When  chemicals  are  used  always 
allow  time  for  the  disinfectant  to  do  its  work.  The 
following  rules  for  prevention  are  recommended  in 
diphtheria  and  with  slight  changes  are  equally  applic- 
able to  scarlet  fever. 

Rules  for  Avoiding  Diphtheria. — Avoid  contact  with 
a diphtheria  patient.  Even  the  mildest  case  of  diph- 
theria is  dangerous.  The  germ  from  a mild  case  may 
impart  the  disease  in  its  most  virulent  form. 

Do  not  let  a child  go  near  a case  of  diphtheria.  Chil- 
dren under  ten  years  of  age  are  in  much  greater  danger 
of  death  from  diphtheria  than  are  adults.  But  adults 


DVANCE,  ETC. 

' of  illness.  On  tonsil, 
Dility,  weak  heart. 

Sore  throat  may  resemble  Scarlet  fever.  Great  danger  from  weak- 
ness of  heart  on  exertion.  Only  free  from  infection  when  germs 
are  absent  from  throat,  etc.  (Bacteriological  examination  neces- 
sary.) 

Infectious  during  attack. 

part  of  chest,  front  and 
ren  vomiting  is  an  early 
uamation  (“skinning”)- 

Resembles  Small-pox,  Measles,  Diphtheria,  Sore  throat.  Is  one  of 
the  most  fatal  diseases  of  children.  Free  from  infection  after  six 
weeks  from  commencement  of  disease,  and  when  discharges 
from  ears,  nose,  etc.,  and  desquamation  have  ceased,  probably 
after  six  weeks  of  commencement  of  illness.  (Bacteriological 
examination  necessary.) 

ler  angle  of  eye,  internal 
ligh  fever,  delirium,  etc. 

Dangerous  for  old  people  and  chronic  alcoholics,  and  in  puerperal 
cases.  Free  from  infection  when  skin  has  finished  peeling. 

irst  on  forehead,  at  roots 
pots”  (inside  cheeks). 

Resembles  German  Measles,  Small-pox,  Scarlet  fever.  Infected 
child  should  be  isolated.  Causes  many  deaths,  and  predisposes 
to  Consumption^^  of  the  lungs  later.  Free  from  infection  after 
all  rash,  etc.,  has  disappeared,  probably  three  weeks  after 
commencement  of  disease  if  attack  is  mild. 

Irst  on  face.  Previously, 
[g  or  earlier  red  “blush.” 
4es,  desquamation,  etc. 

Resemble  Measles,  Scarlet  fever.  Free  from  infection  after  all 
scabs  and  desquamation  have  disappeared. 

5.  Usually  on  abdomen, 
usually  free.  Symptoms 
flushed  face  and  eyes. 
ns. 

One  of  the  most  infectious  diseases.  Now  seldom  seen  except 
among  very  poor  and  dirty  people.  Deaths  among  children 
few.  Free  from  infection  after  cessation  of  fever,  probably  six 
weeks  after  commencement  of  disease. 

-pink  spots  on  abdomen, 

! Characteristic  tempera- 
^ver. 

Resembles  Influenza.  Later  appearance  of  rash  distinguishes  it 
from  Scarlet  fever,  Small-pox,  and  Typhus  fever.  Relapses  may 
occur.  Convalescence  slow.  Free  from  infection  probably 
after  six  weeks.  Bacteriological  examination  necessary. 

jack,  etc.).  Slight  fever, 
Lys. 

Free  from  infection  after  skin  has  become  normal.  Probably  two 
weeks  from  commencement  of  illness. 

1 

Pink  spots  on  face  first. 
[ Slight  fever — 3 days. 

Free  from  infection  when  skin  is  normal,  probably  after  three  weeks 
from  commencement  of  illness. 

k.  ^From  Hygiene  for  Nurses,  Herbert  W.  G.  MacLeod,  B.  Sc.,  M.  D. 


TABLE  OF  INFECTIOUS  DISEASES  (Fevers)^ 


(When  Most  Prevalent j 


Mode  of  Infection 


Diphtheria i All  ages,  Nurses  very 

liable,  and  children  (2 
to  8 years  especially) 


Ert'sipelas. . 


Small-pox 

Tj*phus  Fever. . 


Tjrphoid  Fever. . 


German  Measles . . 
iRotheln) 


Any  age,  chiefly  old 
people. 


All  ages,  specially  chil- 
dren 4 to  7 years. 


Adults  over  40.  Surgical 
and  Post  Partum  cases. 
Children. 

Young  children  chiefly. 


Any  age  if  unvaccinated. 


All  ages. 


Children  specially. 
Children  or  adults. 


October  to  December,  j Air,  Clothing,  Room,  Saliva,  Nasal 
Epidemics.  > Discharges,  etc..  Infected  milk.  Cat, 

Toys,  Bacillus  Diphtheriae. 


Spring  and  Winter. 


November  and  Decem- 
ber, Epidemics. 


Spring. 


June  and  December. 
Epidemics  differ  in  se- 
verity. 


Spring  and  Autumn, 
Epidemics. 


Winter  Epidemics  severe 
but  infrequent. 


March  to  June. 


Bacillus  Pneumonia;. 


Direct  Contagion,  Breath,  Skin,  Clothes, 
Books.  Milk  specially  (cow  may 
probably  get  the  disease).  Discharges 
from  ears  and  nose  of  patient  are  very 
infectious.  Special  germ  unknown. 
Epidemics  vary  in  intensity. 

Contagion.  Inoculation  wounds.  Germ 
of  erysipelas. 


Specially  infectious  before  and  during 
rash.  Neighborhood  of  patient,  Air, 
Clothes.  Discharges  from  nose, 
mouth,  skin. 


Patients  are  infectious  before  rash  ap- 
pears. Air,  Clothing,  Skin,  etc. 
Germ  uncertain. 

Very  infectious,  especially  near  patient 
and  during  second  week  of  illness. 
Bedding,  Clothing,  Furniture  long 
retain  poison.  Germ  not  known.  Es- 
pecially among  filthy  surroundings. 
Overcrowding.  Nurses  are  very  liable 
to  infection. 

Water  and  Milk,  Oysters,  Cockles, 
Vegetables,  Defective  drains,  etc., 
Flies,  Excreta.  Bacillus  Typhosus. 


Air,  Clothing,  Con- 


Immediate  neighborhood  of  patient,  in 
fectious  Clothing,  etc. 


Incubation  Period 


Symptoms  on  Invasion,  Advance,  etc. 


2 days;  it  may 


Short:  2 to  3 days. 


2 to  4 days  (i  to 


Usually  3 days  (3  to  7). 


10  to  12  days. 


Usually  12  days. 


Usually  12  days  (2  to  14). 


About  14  days  (5  to  23). 


Usually  14  days. 
Usually  16  to  18  days. 


Grayish-white  membrane — second  day  of  illness.  On  tonsil, 
uvula,  etc.  Advance:  fever,  great  debility,  weak  heart. 


Early  rigor.  Lung  symptoms. 


Rash  on  second  day  of  illness  on  upper  part  of  chest,  front  and 
sides  of  neck,  sore  throat.  (In  children  vomiting  is  an  early 
symptom.)  Fever  later — finally  desquamation  (“skinning”). 


Redness  on  second  day  of  illness  on  inner  angle  of  eye,  internal 
ear,  etc.  “Blebs,”  swelling  of  face,  high  fever,  delirium,  etc. 
Desquamation  later. 

Rash  on  fourth  day  of  illness.  Usually  first  on  forehead,  at  roots 
of  hair  and  behind  ears.  “Koplik’s  spots”  (inside  cheeks). 


Rash  on  third  day  of  illness,  usually  first  on  face.  Previously, 
intense  backache.  Headache,  vomiting  or  earlier  red  “blush.” 
Later,  secondary  fever,  “ blebs,”  pustules,  desquamation,  etc. 

Rash  (“Mulberry”)  on  fifth  day  of  illness.  Usually  on  abdomen, 
chest,  backs  of  hands.  Face  and  neck  usually  free.  Symptoms 
rapidly  developed:  rigors,  vomiting,  flushed  face  and  eyes. 
Disease  usually  terminates  with  a crisis. 


Rash  at  end  of  first  week:  /ew .small  rose-pink  spots  on  abdomen, 
chest.  Later  intestinal  symptoms.  Characteristic  tempera- 
ture chart.  Lysis  or  crisis  at  end  of  fever. 


Rash  (seen  first  day  of  illness  on  chest,  back,  etc.).  Slight  fever, 
successive  crops,  each  lasting  3 to  4 days. 

Rash  on  second  or  third  day  of  illness.  Pink  spots  on  face  first. 
Enlarged  glands  in  neck.  Sore  throat.  Slight  fever — 3 days. 


Sore  throat  may  resemble  Scarlet  fever.  Great  danger  from  weak- 
ness of  heart  on  exertion.  Only  free  from  infection  when  germs 
are  absent  from  throat,  etc.  (Bacteriological  examination  neces- 
sary.) 

Infectious  during  attack. 


Resembles  Small-pox,  Measles,  Diphtheria,  Sore  throat.  Is  one  of 
the  most  fatal  diseases  of  children.  Free  from  infection  after  six 
weeks  from  commencement  of  disease,  and  when  discharges 
from  ears,  nose,  etc.,  and  desquamation  have  ceased,  probably 
after  six  weeks  of  commencement  of  illness.  (Bacteriological 
examination  necessary.) 

Dangerous  for  old  people  and  chronic  alcoholics,  and  in  puerperal 
cases.  Free  from  infection  when  skin  has  finished  peeling. 


Resembles  German  Measles,  Small-pox,  Scarlet  fever.  Infected 
child  should  be  isolated.  Causes  many  deaths,  and  predisposes 
to  “Consumption"  of  the  lungs  later.  Free  from  infection  after 
all  rash,  etc.,  has  disappeared,  probably  three  weeks  after 
commencement  of  disease  if  attack  is  mild. 

Resemble  Measles,  Scarlet  fever.  Free  from  infection  after  all 
scabs  and  desquamation  have  disappeared. 


One  of  the  most  infectious  diseases.  Now  seldom  seen  except 
among  very  poor  and  dirty  people.  Deaths  among  children 
few.  Free  from  infection  after  cessation  of  fever,  probably  six 
weeks  after  commencement  of  disease. 


Resembles  Influenza.  Later  appearance  of  rash  distinguishes  it 
from  Scarlet  fever.  Small-pox,  and  Typhus  fever.  Relapses  may 
occur.  Convalescence  slow.  Free  from  infection  probably 
after  six  weeks.  Bacteriological  examination  necessary. 


Free  from  infection  when  skin  is  normal,  probably  after  three  weeks 
from  commencement  of  illness. 


Nurses  should  make  it  clear  to  Parents,  etc.,  that  mildness  of  the  attack  in  one  person  does  not  lessen  the  chances  of  another  taking  the  infection,  or  of  having  a virulent  type  of  the  disease. 


’From  Hygiene  for  Nurses,  Herbert  W.  G.  MacLeod,  B.  Sc.,  M.  D. 


COMMUNICABLE  DISEASES  IN  THE  HOME  163 


frequently  get  and  spread  the  disease.  Mild  cases  among 
adults  may  cause  fatal  cases  among  children. 

Do  not  allow  a dog,  cat,  or  other  animal  to  enter  the 
sick-room;  a pet  animal  may  carry  the  disease  to  a child. 

Allow  no  persons  to  visit  the  sick-room.  When  leav- 
ing the  infected  home  the  attendant  should  bathe  the 
body  and  hair  with  some  antiseptic  soap  and  disinfect 
the  clothing. 

Discharges  from  those  sick  with  diphtheria  retain  the 
virulence  for  a long  time.  Care  must  be  taken  to  allow 
no  clothing  in  the  room  that  cannot  be  washed  or 
fumigated. 

Food  into  which  the  diphtheria  contagion  has  gained 
entrance  should  be  most  carefully  avoided.  The 
germ  of  diphtheria  is  so  tenacious  of  life  that  it  may  be 
carried  long  distances.  Milk  has  been  the  means  of  im- 
parting the  disease  in  many  instances. 

Abrasions  of  the  skin  must  be  carefully  covered  with 
court  (or  adhesive)  plaster,  as  they  afford  favorable 
opportunity  for  the  contraction  of  diphtheria. 

Avoid  any  exposure  of  the  throat  at  times  when  diph- 
theria prevails.  Influences  . which  promote  sore  throat 
tend  to  the  spread  of  the  disease. 

Use  no  dish  used  by  the  sick.  Allow  no  ’child  to  use 
any  dishes,  toys,  etc.,  that  have  been  in  the  sick-room. 

In  epidemics  regard  all  persons  having  sore  throat  as 
probable  diphtheria  patients.  Never  kiss  such  patients; 
observe  all  care  about  allowing  children  to  touch  their 
clothes  or  dishes.  Keep  children  away  from  them  as 
much  as  possible. 

Responsible  persons  should  see  to  it  that  in  times  of 
epidemics  individual  drinking-cups  are  supplied  to  and 
used  by  the  children  in  schools.  Diphtheria  germs  have 
been  found  on  cups  in  actual  common  use  in  schools.  A 
foutain-cup  would  be  less  liable  to  spread  disease  than 
an  ordinary  cup,  because  the  water  continually  over- 
flows the  sides  and  tends  to  wash  away  any  infection 
which  might  otherwise  collect  on  the  edges  of  the  cup. 


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When  the  patient  is  recovered  and  released  give  him 
a thorough  bath,  hair  included,  put  on  clothing  which  has 
not  been  in  the  infected  room  and  let  him  go  at  once 
into  another  room. 

The  Room  and  Contents, — After  a diphtheria  case  is 
concluded,  the  room  in  which  there  has  been  a case, 
whether  fatal  or  not,  should,  with  all  its  contents,  be 
thoroughly  disinfected. 

Because  of  the  innumerable  ways  in  which  the  con- 
tagion may  be  scattered  about  the  house  and  premises, 
the  entire  house  and  outbuildings,  including  cellar, 
garret,  woodshed,  and  privy,  will  usually  need  to  be 
disinfected. 

The  disinfection  must  include  not  only  the  room,  but 
also  all  articles,  etc.,  which  have  been  in  the  room.  All 
clothes  and  furniture  must,  therefore,  not  be  removed, 
but  must  be  left  in  the  room  for  disinfection. 

It  is  best  to  burn  all  articles  which  are  not  too  valuable, 
especially  if  they  have  been  soiled  by  discharges  from  the 
nose  or  mouth  of  the  patient.  This  applies  particularly 
to  thick,  resistant  cloths.  If  the  burning  is  done  in 
open  air,  it  should  be  far  from  dwellings  and  by  a quick, 
strong  fire. 

All  articles  which  are  too  valuable  to  be  burned  should, 
if  washable,  be  treated  to  thorough  boiling  in  some  dis- 
infectant solution.  This  should  include  all  cotton,  linen, 
flannels,  blankets,  etc.  These  should  be  introduced  into 
the  solution  piece  by  piece,  so  as  to  make  certain  of 
thorough  wetting,  and  the  boiling  should  be  for  at  least 
half  an  hour.  The  solution  of  which  formula  is  con- 
tained on  page  152  is  especially  suitable  for  flannel 
articles. 

Heavy  clothing,  silk,  or  furs  should  be  hung  in  the 
room  for  fumigation,  pockets  being  turned  inside  out, 
and  tlie  whole  garment  thoroughly  exposed.  IMattresses 
should  be  hung  up  or  otherwise  placed  so  as  to  expose 
both  sides.  Carpets  are  best  taken  up  and  laid  out  on 
chairs,  but  may  be  fumigated  on  the  floor  if  they  are 


COMMUNICABLE  DISEASES  IN  THE  HOME  165 

afterward  removed  to  the  air  and  thoroughly  beaten. 
Pillows  and  upholstered  furniture,  after  being  disinfected 
on  the  outside,  may  well  be  cut  open  and  their  contents 
again  exposed  to  the  distinfecting  gas. 

In  no  case  should  disinfection  of  every  article  of 
clothing,  and  bedding  be  omitted.  As  already  directed 
they  must  be  left  within  the  room  for  this  purpose. 
Infected  clothing  and  bedding  have  been  known  to 
communicate  diphtheria  months  after  the  case  had 
subsided.  Be  sure  that  all  possible  surfaces  are  exposed. 

Tuberculosis  is  not  one  of  the  highly  infectious  diseases 
but  it  is  spread  by  a germ  which  may  enter  the  body 
in  several  ways. 

It  may  be  breathed  into  the  body  by  means  of  floating 
dust  in  the  air. 

It  may  be  taken  into  the  body  with  food  and  drink. 

It  may  enter  through  a wound  in  the  skin. 

It  may  get  into  the  body  by  means  of  dishes  and  table 
utensils,  through  saliva,  through  kissing,  and  in  other 
ways. 

Prevention. — When  there  is  a consumptive  in  the 
home  the  following  rules  should  be  observed: 

1.  The  sputum  or  matter  coughed  up  by  a consump- 
tive should  not  be  spit  upon  the  floor,  carpet,  stove,  wall, 
or  sidewalk,  but  always,  if  possible,  in  a cup  kept  for 
that  purpose. 

^^When  a metal,  glass,  or  earthenware  cup  is  used  it 
should  contain  5 per  cent,  solution  of  carbolic  acid,  to 
prevent  the  sputum  from  drying  and  destroy  the  germs. 
The  cup  should  be  emptied  into  the  water-closet  at  least 
twice  a day  and  thoroughly  washed  with  boiling  water. 

When  consumptives  are  away  from  home  the  sputum 
should  be  received  into  a pocket-flask  of  glass,  metal,  or 
pasteboard. 

Whatever  receptacle  is  used  it  should  have  a cover, 
so  that  flies  may  not  have  access  to  its  contents. 

Patients  too  weak  to  use  a cup  should  use  moist 
rags,  which  should  at  once  be  burned. 


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If  cloths  or  handkerchiefs  are  used  by  a consumptive 
they  should  not  be  carried  loose  in  the  pocket,  but  in  a 
waterproof  receptacle,  such  as  a tobacco  pouch,  which 
should  be  frequently  boiled.  If  handkerchiefs  are  used 
they  should  not  be  put  in  a laundry  bag  or  receptacle 
with  other  soiled  linen,  but  should  be  kept  immersed  in  a 
5 per  cent,  carbolic  solution,  or  should  be  boiled  at  once 
in  water  for  at  least  half  an  hour. 

consumptive  should  never  swallow  his  sputum. 
Sputum  swallowed  may  spread  the  disease  to  other 
organs.  The  hands  should  be  washed  and  the  mouth 
rinsed  out  before  eating. 

^^2.  Great  care  should  be  taken  by  the  consumptives 
to  prevent  their  hands,  face,  and  clothing  from  becoming 
soiled  by  their  sputum.  If  they  do  thus  become  soiled 
they  should  at  once  be  washed  with  soap  and  water. 

^^3.  Consumptives  should  always  hold  a cloth  or  hand- 
kerchief before  the  face  during  coughing  or  sneezing,  lest 
germs  be  scattered  in  the  small  particles  of  spittle  that 
are  then  forcibly  expelled. 

^^4.  A male  consumptive  should  be  clean  shaven. 
Hair  about  the  face  is  apt  to  retain  the  germs  existing 
in  particles  of  spittle  ejected  during  coughing  or 
sneezing. 

^^5.  A consumptive  should  have  his  own  bed  and,  if 
possible,  his  own  room.  Both  the  bed-room  and  living- 
room  should  have  as  much  direct  sunlight  as  possible, 
and  should  always  have  an  abundance  of  fresh  air — 
the  window  should  be  open  day  and  night.  Many  con- 
sumptives have  benefited  greatly  from  sleeping  out  of 
doors  in  tents,  on  roofs  or  piazzas. 

^'6.  The  rooms  should  be  cleaned  daily,  but,  to  pre- 
vent the  raising  of  dust,  all  dusting  should  be  done  with 
damp  cloths,  and  before  sweeping  floors  must  be  well 
sprinkled  with  sawdust,  small  scraps  of  paper,  or  tea 
leaves,  all  thorougldy  moistened. 

^^7.  A consumptive’s  soiled  clotlies  and  bed  linen 
should  be  handled  as  little  as  possible  when  dry,  but 


COMMUNICABLE  DISEASES  IN  THE  HOME  167 

should  be  kept  immersed  in  water  until  the  washing  is  to 
be  done. 

8.  All  rooms  or  apartments  which  have  been  occupied 
by  persons  suffering  from  consumption  must,  on  death 
or  removal,  be  thoroughly  disinfected.  No  other  persons 
should  be  allowed  to  reside  therein  until  this  rule  has 
been  complied  with. 

^^9  A consumptive  woman  should  not  nurse  an  infant. 
It  drains  the  strength  of  the  mother  and  subjects  the 
child  to  the  danger  of  infection.^^^ 

The  room  occupied  by  a consumptive  patient  should  be 
well  lighted  and  ventilated,  even  if  there  is  no  hope  of  a 
cure.  The  dangerous  qualities  of  the  sputum  are  dimin- 
ished quickly  by  exposure  to  sunlight  and  fresh  air. 
Sunshine  is  one  of  the  best  disinfectants,  and  a room 
flooded  with  sunshine  is  far  less  dangerous  to  those  who 
are  associated  with  the  patient.  The  dilution  of  the 
atmosphere  with  fresh  air  also  lessens  the  danger  of 
contracting  the  disease. 

Predisposing  Diseases, — Patients  who  have  suffered 
from  grippe,  pneumonia,  measles,  bronchitis,  and  other 
diseases  in  which  the  respiratory  organs  have  been 
affected,  should  especially  guard  against  this  disease. 
The  diseases  mentioned  have  paved  the  way  for  consump- 
tion in  many  cases.  These  patients  should  remain  under 
treatment  and  avoid  exposure  to  cold,  damp,  or  sudden 
changes  of  temperature  until  their  normal  health  has 
been  fully  established. 

The  infectious  character  of  consumption  has  been  over- 
estimated by  many.  Tuberculosis  is  not  contagious  in 
the  same  way  as  diphtheria,  scarlet  fever,  or  small-pox, 
and  much  harm  is  done  through  a totally  unwarranted 
fear  of  consumptives.  It  is  said  by  eminent  authorities 
that  one  is  less  in  danger  of  contracting  the  disease  in  a 
sanitarium  for  this  class  of  patients  than  almost  any- 
where else.  In  localities  where  such  institutions  are 
located  the  mortality  from  consumption  has  markedly 

^ Bulletin  Ontario  Board  of  Health. 


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decreased.  The  patient  is  only  a source  of  danger 
through  discharges  from  diseased  tissues,  chiefly  the 
sputum,  and  if  these  are  properly  cared  for,  contact 
with  the  consumptives  is  practically  free  from  danger. 

The  danger  of  infection  is  greatest  in  the  house  or 
workshop  or  office  where  the  sun  has  less  opportunity  to 
do  its  preventive  work  than  outside.  Dark  rooms  or 
dwellings  are  always  dangerous,  and  alleys,  courts  and 
dwellings  shut  off  from  light  are  especially  good  breeding 
places  for  the  disease. 

Points  to  be  Remembered. — A good  conscience  as  well 
as  intelligence  and  judgment  should  be  possessed  by  the 
home  nurse  in  charge  of  an  infectious  patient. 

Nothing  unnecessary  in  the  room’^  is  a good  rule  in 
such  cases. 

A broom  or  dust  cloth  used  promiscuously  when  an 
infectious  patient  is  being  nursed  may  easily  spread  the 
disease. 

Nothing  is  small  enough  to  be  careless  about  in  dealing 
with  communicable  diseases. 

Contact  infection  is  the  chief  danger  to  be  feared. 

Soap  and  water  applied  freely  to  the  hands  and  utensils 
is  a thousand  fold  greater  safeguard  than  a wet  sheet 
before  the  door. 

Floors  and  woodwork  should  be  gone  over  every  day 
with  a damp  cloth  wet  with  a disinfectant. 

The  germs  of  disease  easily  find  lodgment  in  the  hair 
and  may  be  spread  through  the  house  in  that  way. 

A toy  or  book  too  valuable  to  be. burned  should  not  be 
given  to  a child  who  has  an  infectious  disease. 

The  home  nurse  who  is  in  charge  of  a patient  with 
diphtheria,  scarlet  fever  or  any  acute  communicable 
disease  should  study  carefully  the  rules  given  for  pre- 
vention of  the  disease. 

One  little  article  which  was  not  disinfected  or  which 
was  too  valuable  to  burn,  has  held  the  germs  for  months 
and  caused  the  disease  which  resulted  in  death. 

Four  things  are  essential  to  a cure  in  a consumptive 


COMMUNICABLE  DISEASES  IN  THE  HOME  169 


patient:  rest,  freedom  from  worry,  plenty  of  good  food, 
plenty  of  fresh  air. 

If  proper  care  is  taken  of  the  matter  which  a con- 
sumptive spits  up,  there  is  little  danger  of  contracting 
the  disease. 

The  tuberculosis  germ  flourishes  in  dark,  unventilated 
rooms  which  are  not  kept  clean. 

Remember  that  sunshine  is  an  efficient  germ  destroyer. 
Give  it  a chance  when  dealing  with  communicable 
diseases. 


REVIEW  QUESTIONS. 

1.  How  would  you  arrange  the  room  for  the  care  of  an  infectious 
patient  ? 

2.  What  utensils  should  the  home  nurse  secure  for  the  proper 
sanitary  care  of  the  room  ? 

3.  In  doing  the  routine  work  of  caring  for  infectious  patients 
what  measures  should  a nurse  use  to  avoid  contracting  the 
disease  herself  ? 

4.  What  precautions  should  be  used  in  regard  to  dishes  and  uten- 
sils? 

5.  How  may  the  germs  of  disease  be  spread  in  the  following 
diseases:  typhoid  fever,  diphtheria,  measles,  scarlet  fever? 

6.  Outline  the  general  preventive  measures  that  should  be 
observed  in  regard  to  diphtheria  and  scarlet  fever. 

7.  How  should  a room  and  contents  be  arranged  for  fumigation  ? 

8.  How  may  the  tuberculosis  germ  gain  entrance  to  the  body  ? 

9.  Give  a complete  set  of  precautions  which  should  be  observed 
to  prevent  a tuberculosis  patient  spreading  the  disease. 

10.  Mention  some  conditions  which  render  it  easier  for  a person 
to  contract  tuberculosis. 


CHAPTER  XX. 


A LESSON  ON  BANDAGING. 

Demonstration  and  Practice  Work. — Application  of  roller  and 
triangular  bandages  to  human  subject. 

There  are  very  few  homes  in  which  bandages  do  not 
at  some  time  become  a necessity.  Bandaging,  like 
most  other  useful  arts,  is  one  that  requires  practice. 
The  first  attempts  may  be  bungling  and  discouraging, 
but  even  without  a teacher  a good  deal  of  skill  can  be 
developed,  simply  by  following  the  pictures  and  the 
printed  directions. 

Skill  in  bandaging  depends  on  two  things: 

A keen  perception  of  the  purpose  for  which  the  bandage 
is  applied. 

Manual  dexterity  in  putting  it  on. 

The  neatest  looking  bandage  is  not  always  the  best, 
though  neatness  is  to  be  cultivated.  The  proper  amount 
of  pressure  made  by  the  bandage  and  the  amount  of 
support  given  to  the  part  are  important  points  to  be  kept 
in  mind  when  putting  on  any  bandage. 

Uses  of  Bandages. — 1.  To  retain  dressings  or  splints  in 
position. 

2.  To  support  injured  parts. 

3.  To  make  even,  steady  pressure  on  a part. 

4.  To  check  hemorrhage. 

5.  To  protect  wounds  from  exposure. 

The  roller  bandage,  the  abdominal,  and  the  triangular 
bandage  are  those  best  adapted  for  home  use.  To  make 
a roller  bandage  see  below. 

From  four  to  five  yards  should  be  provided  for  band- 
aging a foot  and  ankle.  Two  and  a half  inches  wide  is  a 
good  width  for  bandages  for  the  head,  arm,  or  leg.  For 

170 


A LESSON  ON  BANDAGING 


171 


a roller  bandage  for  the  breast,  three  to  three  and  a half 
inches  is  better. 

The  following  rules  for  applying  a roller  bandage  will 
be  helpful  to  keep  in  mind: 

1.  Have  the  bandage  tightly  rolled  before  applying. 


Fig.  31. — Spiral 
reversed  bandage  of 
the  lower  extremity. 
(DaCosta.) 


Fig.  32. — Spica  of  the 
instep.  {DaCosta.) 


Study  to  apply  it  smoothly  and  never  attempt  to  re- 
apply without  first  winding  it  up. 

2.  The  limb  to  be  bandaged  should  be  held  in  the  posi- 
tion it  is  to  be  kept  with  the  bandager  standing  in  front. 
An  arm  should  be  held  with  the  elbow  flexed  and  the 
thumb  pointing  upward. 


Fig.  33. — Spiral  reversed  bandage  of  the  upper  extremity.  {DaCosta.) 

3.  Apply  the  outside  of  the  bandage  to  the  inside  of 
the  limb  and  fix  the  end  with  a couple  of  turns  around  the 
limb  in  starting. 

4.  Bandage  from  below  upward  and  from  within  out- 
ward over  the  front  of  the  limb. 

5.  Allow  each  turn  of  the  bandage  to  overlap  by  about 


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two-thirds  the  preceding  turn,  and  never  unroll  more 
than  2 or  3 inches  of  the  bandage  at  a time. 

6.  Apply  the  bandage  firmly,  but  never  too  tightly  nor 
too  Joosely.  The  bandage  is  too  loose  if  the  edges  turn 
up  on  running  the  hand  down  over  it  after  the  bandage 
is  on. 

7.  Endeavor  to  use  firm,  equal  pressure.  The  pressure 
of  red  lines  on  the  surface  of  the  skin  after  removal  of  a 
bandage  indicates  unequal  pressure. 

8.  Leave  the  tips  of  fingers  and  toes  uncovered.  If 
these  become  blue  the  bandage  should  be  loosened. 


Fig.  34. — Four-tailed  and  many- 
tailed bandages.  {Stoney.) 


Fig.  35. — Scultetus  bandage. 
{Stoney.) 


9.  Never  apply  a bandage  wet.  When  dry  it  will 
shrink  and  be  too  tight. 

10.  Avoid  reversing  over  a sharp,  bony  prominence, 
and  keep  the  reverses  in  a line  on  the  outer  side  of  the 
limb. 

11.  In  bandaging  a joint  always  use  a figure-of-eight. 

12.  In  removing  a bandage  gather  up  the  loose  part 
and  carry  it  around  the  limb. 

An  abdominal  bandage  may  be  needed  for  support 
under  various  conditions.  A roller  towel  can  be  used 
in  emergency,  or  a bolster  cover.  If  a bandage  has  to 
be  made  for  the  purpose  it  should  be  double  and  deep 
enough  to  come  well  down  over  the  hip  bones,  and  long 
enough  to  lap  two  inches  on  each  side  in  front.  To 
apply  it,  arrange  it  evenly  and  begin  to  pin  in  the  middle 
of  the  bandage  in  front  using  strong  safety  pins.  Pin 


A LESSON  ON  BANDAGING 


173 


as  tightly  as  it  can  be  drawn,  with  the  hand  underneath. 
When  the  hand  is  withdrawn  it  should  be  comfortably 
snug.  Pin  first  downward  from  the  middle,  then  up- 


POINT 


Fig.  36. — Triangular  bandage.  {Warwick  and  Tunstall.) 


A 


Fig.  37. — Method  of  folding  triangular  bandage  broad  and  narrow  for  use. 
{Warwick  and  Tunstall.) 

ward,  fitting  the  bandage  in  at  the  waist  by  pinning  a 
gore  in  at  each  side.  Such  a bandage  needs  to  be  re-ad- 
justed and  tightened  often,  especially  if  the  patient  is 


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moving  around.  If  it  is  not  kept  in  place  and  fitting 
snugly  to  the  form,  it  is  not  giving  support  and  might 
as  well  be  discarded. 

The  triangular  bandage  is  made  by  taking  a piece  of 


Fig.  38. — The  triangular  bandage  for  the  whole  hand.  {Warwick  and  T unstall.) 

cotton  al)out  one  yard  square,  folding  it  diagonally  and 
cutting  it  along  the  fold.  Each  of  the  triangles  thus 
secured  forms  one  l)andage. 

The  base  of  the  triangle  forms  the  lower  border;  the 


A LESSON  ON  BANDAGING 


175 


two  sides,  the  side  borders;  the  apex,  the  point;  the 
remaining  corners  of  the  triangle,  the  two  ends. 

The  triangular  bandage  has  the  following  advan- 
tages:^ It  can  easily  be  made  from  a handkerchief  and 
is  therefore  well  suited  for  an  emergency  bandage.  Its 
application  may  be  easily  acquired;  temporary  dressings 


Fig.  39. — The  large  arm  sling  ap-  Fig.  40. — The  large  arm  sling  ap- 
plied as  a support  for  the  elbow.  plied  as  a support  for  the  elbow. 

{Warwick  and  Tunstall.)  {Warwick  and  Tunstall.) 


may  be  fixed  better  with  it  than  with  a roller  bandage 
and  it  can  be  used  for  almost  every  purpose  for  which  a 
bandage  is  required.^’ 

The  Narrow  Arm  Sling, — This  is  applied  by  first  fold- 
ing the  bandage  narrow,  then  placing  one  end  over  the 
shoulder  of  the  uninjured  side  and  allowing  the  other 
end  to  hang  down  in  front.  The  forearm  is  now  bent  to 
the  required  height,  and  the  hanging  end  is  drawn  up  in 

^ First  Aid  to  the  Injured,  Warwick  and  Tunstall, 


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front  of  it  and  over  the  shoulder  of  the  injured  side,  and 
the  two  ends  are  then  tied  behind  the  neck/^ 

As  a Support  for  the  Elbow, — Place  the  triangular 
bandage  with  one  end  on  the  shoulder  of  the  injured  side 
and  the  apex  pointing  in  the  opposite  direction  to  the 
elbow;  then  flex  the  forearm  on  the  injured  side,  and 
place  it  across  the  front  of  the  chest,  with  the  fingers 
touching  the  opposite  shoulder.  Now  draw  the  lower 
end  over  the  elbow,  and  across  the  front  of  the  chest  to 
the  top  of  the  shoulder  on  the 
uninjured  side  and  tie  it  to  the 
upper  end.  Then  take  the  apex, 
fold  it  well  over  the  forearm,  and 
pin  it  to  the  bandage  above  on 
the  injured  side.’^ 

‘‘For  a Wound  of  the  Scalp, — 
First  fold  the  lower  border  of  the 
bandage  lengthwise  to  form  a hem 
1 1/2  inches  wide,  then  place  it 
with  the  middle  of  the  hem  over 
the  center  of  the  forehead  just 
above  the  root  of  the  nose,  and 
the  point  hanging  over  the  back 
of  the  head  to  the  neck.  Now  carry  the  two  ends  back- 
ward above  the  ears  which  are  left  out,  cross  the  ends 
behind  at  the  nape  of  the  neck  over  the  point;  bring 
the  ends  forward  and  tie  them  in  front  on  the  fore 
head.  Next  draw  the  point  down  to  make  the  bandage 
fit  well  over  the  head,  then  turn  it  over  the  top  of  the 
head  and  pin  it. 

“For  a Wound  of  the  Hand, — Spread  out  a bandage 
unfolded,  place  the  hand  upon  it  with  the  wrist  on  the 
center  of  the  lower  border,  palm  downward  and  the 
finger  toward  the  point.  Turn  the  point  over  tlie 
fingers  and  carry  it  across  to  the  back  of  the  wrist,  then 
draw  the  bandage  downward  on  each  side  of  the  hand, 
and  pass  the  ends  upward  round  the  back  of  the  wrist; 
cross  them  over  the  point,  then  carry  them  in  front  of  the 


Fig.  41. — The  triangular 
bandage  for  the  head.  ( War- 
wick and  T unstall.) 


A LESSON  ON  BANDAGING 


177 


wrist;  bring  them  back  again,  and  tie  them  over  the 
point.  Now  draw  the  point  over  the  knot  and  pin  it  to 
the  bandage  below. 

For  a Wound  of  the  Foot, — Spread  out  a triangular 
bandage  unfolded;  place  the  foot  on  the  center  of  it 
with  the  toes  toward  the  point,  draw  the  point  upward 
over  the  instep.  Take  one  of  the  ends 
in  each  hand  close  up  to  the  foot,  bring 
them  forward  round  the  ankle  to  the 
front  and  over  the  point,  cross  them  on 
the  instep,  carry  the  ends  back  round 
the  ankle,  cross  them  behind,  catching 
the  lower  border  of  the  bandage,  bring 
them  forward  again,  and  tie  in  front  of 
the  ankle.  Now  draw  the  point  well 
over  the  knot  and  pin  it  to  the  band- 
age below.’’ 

Points  to  be  Remembered. — Have  your 
bandage  properly  made  and  rolled,  and 
know  what  you  want  to  use  it  for  before 
you  try  to  apply  it. 

Always  have  the  limb  in  the  position 
in  which  it  is  desired  to  remain  before 
beginning  to  bandage. 

Be  sure  always  to  leave  the  tips  of  the 
fingers  and  toes  uncovered.  A bandage 
too  tight  may  cause  serious  trouble  by  for^he^fooL^cfc 
interfering  with  circulation.  Tunstaii.) 

In  removing  a bandage  always  gather  the  loose  parts 
and  carry  around  the  limb. 

Bandaging  like  playing  the  piano  requires  practice  if 
one  is  to  become  expert. 

The  triangular  bandage  is  one  of  the  most  useful  and 
most  easily  obtained  of  all  bandages.  It  can  be  applied 
to  almost  any  part  of  the  body  to  retain  dressings  or 
give  support  to  an  injured  part. 

The  abdominal  bandage  needs  frequent  readjustment 
or  it  will  ride  up  over  the  hip  bones.  It  should  be  pinned 
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as  snug  as  can  be  comfortably  borne,  beginning  to  pin  in 
the  middle  and  fitting  it  in  with  pins  ,at  the  waist. 

REVIEW  QUESTIONS. 

1.  On  what  two  things  does  skill  in  bandaging  chiefly  depend? 

2.  How  would  you  prepare,  a roller  bandage  for  a fracture  of 
the  upper  arm  ? 

3.  For  what  purposes  are  bandages  useful? 

4.  Outline  the  rules  which  should  be  observed  in  putting  on  a 
roller  bandage. 

5.  Mention  some  precautions  which  should  be  used  in  bandaging 
an  injured  foot  and  give  reasons. 

6.  How  would  you  make  a triangular  bandage  ? 

7.  How  would  you  apply  the  triangular  bandage  as  a sling  to 
support  an  injured  forearm? 

8.  If  obliged  to  bandage  an  eye  with  the  triangular  bandage 
how  would  you  do  it  ? 

9.  Describe  the  method  of  applying  a triangular  bandage  to  the 
whole  hand. 

10.  How  would  a triangular  bandage  be  applied  to  the  knee? 


CHAPTER  XXL 


ACCIDENTS  AND  EMERGENCIES. 

Demonstration  and  Practice  Work. — Methods  of  checking  hemor- 
rhage and  rendering  first  aid  in  various  emergencies.  Removing 
dressings  from  a wound  (imaginary  or  real)  and  applying  fresh 
dressings.  Disinfection  of  hands. 

Wounds  of  some  kind  constitute  a considerable  por- 
tion of  the  accidents  with  which  the  home  nurse  will  have 
to  deal.  These  will  vary  from  a scratch  or  abrasion  of 
the  skin,  or  superficial  cuts,  to  deep  wounds  with  serious 
hemorrhage  which  call  for  prompt  heroic  action. 

Common  sense  is  the  first  requisite  in  emergencies  of 
all  kinds.  Some  women  and  girls  pride  themselves  on 
being  so  sympathetic  that  they  are  useless  when  a real 
emergency  happens.  They  relate  with  an  air  of  pride 
how  near  they  came  to  fainting  when  this  or  that  acci- 
dent happened.  This  is  a weakness  which  can  be  over- 
come and  the  best  way  to  do  it  is  to  resolve  first  of  all  to 
forget  self,  and  do  as  they  would  want  others  to  do  for 
them  if  they  were  injured.  Such  tendencies  are  in- 
creased by  boasting  of  them  and  will-power  can  over- 
come them  in  any  one  who  earnestly  desires  to  be  useful. 

Wounds. — In  dealing  with  wounds  in  general  the  first 
things  to  be  done  are: 

To  check  the  bleeding. 

To  cleanse  the  wound. 

To  keep  the  wounded  parts  at  rest. 

To  protect  the  wound  from  outside  dust  or  dirt  by 
means  of  some  clean  dressing  material. 

Do  not  touch  a wound  with  dirty  hands  or  instruments. 
Do  not  apply  cobwebs  or  tea  leaves  or  any  such  substance 
to  check  the  bleeding.  Even  if  the  wound  and  surround- 

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ing  parts  seem  to  be  dirty  there  is  no  justification  in 
introducing  more  dirt.  If  it  is  impossible  to  cleanse  the 
hands  before  rendering  first  aid,  cover  the  wound  with  a 
piece  of  clean  old  linen  soaked  in  a solution  made  by  dis- 
solving a teaspoonful  of  clean  table  salt  in  a pint  of 
boiled  water,  and  keep  this  dressing  in  place  with  a 
bandage. 

To  Check  the  Bleeding, — In  superficial  wounds  the  cut 
blood-vessels  tend  to  close  readily  by  the  formation  of  a 
clot.  If  bleeding  continues  apply  clean  water  as  hot  as 
can  be  borne,  or  clean  ice  cold  water  if  it  is  at  hand,  or 
use  direct  pressure  with  a bit  of  clean  cotton  held  over 
the  bleeding  point. 

If  bleeding  is  excessive  apply  firm  pressure  over  the 
main  blood-vessel  from  which  the  bleeding  comes.  Pres- 
sure with  the  thumb  may  be  maintained  until  further  aid 
can  be  secured.  Pressure  with  the  thumb  is  especially 
applicable  to  wounds  about  the  face  and  neck. 

If  bleeding  is  from  a leg  or  arm,  elevate  the  injured 
part  and  keep  it  elevated  for  several  hours  after  bleeding 
has  ceased.  Direct  pressure  may  be  made  by  means  of 
what  is  called  a tourniquet  which  may  be  improvised 
from  a bandage  or  handkerchief. 

Do  not  give  stimulants  such  as  whiskey,  brandy,  or 
wine,  unless  ordered  to  do  so  by  the  doctor.  Stimulants 
tend  to  increase  the  bleeding.  In  cases  of  extreme 
exhaustion  or  shock,  stimulation  may  be  necessary,  but 
should  be  used  with  great  caution. 

In  surface  wounds,  an  application  of  gauze  or  linen 
soaked  in  Friar’s  Balsam  (obtainable  at  any  drug  store) 
is  an  excellent  dressing.  It  tends  to  prevent  infection 
and  promote  healing. 

Disinfect  the  hands  l)efore  l)eginning  to  dress  any  wound 
and  scald  or  boil  every  basin  and  instrument  before  use, 
to  guard  against  introducing  anything  injurious  into  the 
wound.  AVhen  a l)asin  has  been  boiled  always  handle 
from  the  outside.  If  necessary  to  sterilize  a couple  of 
basins  quickly  place  one  over  the  fire  with  a little  water 


ACCIDENTS  AND  EMERGENCIES 


181 


and  place  the  other  inverted  over  it.  Boil  for  ten 
minutes. 

Cleanse  the  hands  by  scrubbing  hard  with  hot  soap 
and  water  and  a stiff  hand  brush  for  at  least  three  minutes. 
Underneath  the  finger-nails  is  a favorite  lodging  place 
for  dirt  and  germs  of  all  kinds  which  readily  gain  access 
to  a wound  through  the  handling  of  dessings,  etc.  To 
guard  against  this  see  that  the  finger-nails  are  clipped 


Fig.  43. — The  wrong  way  to  handle  a surgical  basin, 


short,  and  scraped  underneath  before  beginning  to 
scrub.  After  the  nails  have  been  thoroughly  scraped, 
rub  the  hands  with  a piece  of  washing  soda  and  water 
and  afterward  soak  them  in  some  disinfectant  solution 
such  as  bichloride  of  mercury  one  part  to  two  thousand 
parts  of  water  or  carbolic  acid  solution  (see  page  156). 
If  neither  of  these  is  at  hand,  soak  the  hands  after  thor- 
ough scrubbing,  in  hot  salt  solution  for  five  minutes. 
Hand  disinfection  cannot  be  accomplished  in  a minute 
or  two.  It  takes  time  to  scrub  and  soak  the  skin  so  that 


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the  germs  from  the  hands  will  not  get  into  a wound  and 
into  the  blood  through  carelessness.  A large  proportion 
of  wounds  become  infected  and  are  hindered  from  prompt 
healing  because  poisonous  germs  from  the  fingers  of  nurse 
or  attendant  have  gotten  into  the  wound  during  the 
dressings.  This  is  one  point  which  home  nurses  cannot 
be  too  particular  about.  If  a thing  is  worth  doing  at 
all  it  is  worth  doing  in  the  right  way. 


Fig.  44. — The  right  way  to  handle  a basin. 


Dressings  for  wounds  are  commonly  made  of  absorb- 
ent gauze  and  cotton.  Any  clean  old  linen  such  as  old 
handkerchiefs,  table  napkins,  etc.,  may  be  used.  It  is 
wise  to  soak  even  the  cleanest  dressing  material  in  some 
disinfectant  solution  especially  if  the  wound  has  been 
made  by  a dirty  instrument  or  by  machinery.  In  re- 
moving a dressing  or  adhesive  plaster  from  a wound  avoid 
pulling  the  edges  of  the  wound  apart.  Loosen  the  dress- 
ing gradually  from  both  sides  toward  the  wound. 

Burns. — One  of  the  best  emergency  dressings  is  made 


ACCIDENTS  AND  EMERGENCIES 


183 


by  soaking  a piece  of  clean  gauze  or  cotton  in  a solution 
made  by  dissolving  a teaspoonful  of  baking  soda  in  a cup 
of  water.  When  there  is  need  for  a complete  dressing 
olive  oil  may  be  put  on,  or  if  obtainable  a preparation 
known  as  unguentine  which  can  be  gotten  at  most 
uptodate  drug  stores. 

Carron  oil  is  made  by  mixing  equal  parts  of  linseed  oil 
and  lime  water.  This  is  an  old  fashioned  application 
for  burns  which  is  always  useful. 

When  the  clothing  is  on  fire  make  the  unfortunate  one 
lie  down  and  wrap  tightly  around  him  a blanket,  rug, 
large  coat — anything  large  enough  to  cover  the  body. 
Everything  possible  should  be  done  to  keep  the  flames 
from  the  face,  and  the  hot  air  from  entering  the  lungs. 

Frost  Bites. — The  best  treatment  is  friction  using  ice 
or  snow.  The  temperature  of  the  room  should  be  very 
gradually  elevated. 

Sprains. — Put  the  part  at  rest.  If  an  arm,  support  in 
a sling.  If  a leg,  apply  a splint  or  support  and  keep  it 
slightly  elevated.  The  pain  may  be  relieved  by  the  use 
of  hot  fomentations  or  an  ice  poultice.  In  all  such  cases 
the  injured  tissues  may  be  expected  to  take  from  two  to 
six  weeks  to  repair.  For  a sprained  ankle  it  is  best  to 
get  a doctor  to  firmly  strap  it  with  adhesive  strapping. 
This  strapping  needs  to  be  renewed  after  about  four  to 
six  days.  Deep  rubbing  is  helpful  in  the  later  stages. 

Drowning. — Usually,  restorative  measures  are  directed 
to  filling  the  lungs  with  air  and  trying  to  force  the  blood 
on  through  the  left  side  of  the  heart.  The  mouth  is 
cleared  of  mucus  with  the  finger,  the  tongue  drawn  for- 
ward, and  the  clothing  removed,  keeping  the  patient  on 
the  left  side  if  possible.  Depress  the  tongue  with  the 
curved  forefinger,  turn  the  face  downward,  slap  between 
the  shoulders  to  remove  as  much  of  the  accumulated 
water  and  obstruction  to  breathing.  Keeping  the  tongue 
drawn  forward,  commence  artificial  respiration.  The 
arms  are  drawn  away  from  the  sides  and  upward  so  as  to 
meet  over  the  head.  They  are  then  brought  down  to 


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the  sides,  and  the  elbows  made  to  almost  come  together 
over  the  chest.  These  movements  are  continued  at  the 
rate  of  about  sixteen  to  the  minute,  till  breathing  is 
started  or  till  pulse  and  respiration  have  ceased  for  an 
hour.  Smelling  salts  are  helpful  in  encouraging  breath- 
ing. Friction,  warm  blankets,  and  external  heat,  are 
needed  when  the  breathing  has  started. 

Internal  Hemorrhage. — In  severe  hemorrhage  from  the 
lungs  or  stomach: 

1.  Send  for  medical  assistance. 

2.  Keep  the  patient  on  his  side  or  back,  with  head  and 
shoulders  slightly  elevated  by  pillows,  and  absolutely 
quiet.  Allow  no  talking  or  exertion. 

3.  Admit  plenty  of  fresh  air  and  remove  all  constrict- 
ing bands. 

4.  Give  bits  of  ice  to  swallow,  strong  iced  tea,  or 
vinegar  and  ice  water. 

5.  Apply  an  ice-cap  over  the  chest. 

6.  If  the  patient  is  faint  apply  warmth  to  the  feet  and 
smelling  salts  to  the  nostrils.  Stimulants  if  used  at  all 
should  be  used  with  extreme  caution  in  such  cases. 

Hemorrhage  from  the  Nose : 

1.  Keep  the  patient  sitting  up. 

2.  Never  allow  him  to  hold  his  head  over  a basin. 

3.  Give  plenty  of  fresh  air  and  keep  the  arms  stretched 
upward,  above  and  behind  the  head. 

4.  Pinch  the  nose  below  the  bridge  between  the 
thumb  and  forefinger. 

5.  Spraying  the  nostrils  with  an  alum  solution,  using 
one  to  two  teaspoons  of  alum  to  a pint  of  water,  may  be 
tried  in  extreme  cases. 

If  these  measures  do  not  check  the  bleeding  a physi- 
cian should  be  summoned. 

In  shock  (a  veiy  severe  depression)  the  face  is  pale, 
pinched,  and  anxious.  There  is  great  prostration  of 
strength,  coldness  of  the  skin,  cold  perspiration,  pulse 
weak  and  rapid,  pupils  dilated.  Temperature  often 
subnormal,  but  not  always. 


ACCIDENTS  AND  EMERGENCIES 


185 


Keep  the  patient  lying  down,  absolutely  quiet,  with 
head  low.  Apply  friction  and  heat  to  the  extremities. 
Stimulation  by  mouth  should  be  given,  or  a stimulating 
enema  of  hot  coffee  or  salt  solution. 

Shock  may  easily  be  mistaken  for  concealed  hemor- 
rhage, as  many  of  the  same  symptoms  are  found  in  both 
cases. 

Fainting  is  caused  by  an  insufficient  supply  of  blood 
to  the  brain.  Remove  all  tight  bands  and  constricting 
clothing.  Keep  the  patient  flat  on  his  back,  with  feet 
elevated.  Dash  cold  water  on  the  face.  Hold  smelling 
salts  to  the  nostrils  and  give  stimulants. 

Apoplexy  is  due  to  the  bursting  of  a diseased  blood- 
vessel into  or  on  the  surface  of  the  brain,  causing  com- 
pression of  the  brain.  It  occurs  most  frequently  in 
elderly  people.  Elevate  slightly  and  apply  cold  to  the 
head.  Loosen  all  clothing.  Apply'  heat  to  the  feet. 
Give  no  stimulants,  fluid,  or  food  of  any  kind  by  mouth 
and  secure  a physician  as  quickly  as  possible. 

Sunstroke. — There  are  two  conditions  which  are  simi- 
lar— heat  exhaustion  and  heat-stroke.  The  former  is  a 
condition  of  extreme  prostration,  collapse,  and  some- 
times delirium,  caused  by  prolonged  exposure  to  a high 
temperature.  It  may  occur  at  night  or  in  any  season  of 
the  year.  In  heat  exaustion  the  temperature  may  be 
subnormal  and  stimulants  and  hot  baths  are  frequently 
needed. 

Sunstroke  proper  occurs  as  the  result  of  exposure  to 
the  sun  rays  while  taking  active  exercise  or  doing  hard 
physical  work.  Persons  addicted  to  alcohol  are  more 
susceptible  than  others.  Death  may  occur  instantly  or 
in  a very  short  time,  the  patient  remaining  in  a condi- 
tion of  stupor  till  death  occurs.  Temperature  may 
reach  108°  to  110°  F.  The  temperature  should  be 
reduced  as  rapidly  as  possible  by  ice-baths,  ice-packs, 
or  ice-water  injections  into  the  bowel.  Get  the  doctor 
as  soon  as  possible. 

Foreign  bodies  on  the  surface  of  the  eye,  such  as 


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cinders,  dust,  etc.,  may  be  removed  in  most  cases  with- 
out much  difficulty.  If  under  the  upper  lid  the  lid 
should  be  everted.  To  evert  the  upper  lid  draw  the  lid 
down  hold  a toothpick  or  probe  or  lead-pencil  across  it, 
and  roll  the  lid  back  over  the  instrument.  This  exposes 
the  upper  part  of  the  eye-ball  and  a large  part  of  the 
surface  inside  the  lid.  A twist  of  absorbent  cotton 
around  a probe  or  toothpick  or  a clean  camel’s-hair 
brush  dipped  in  water  may  then  be  swept  over  the 
exposed  surface  very  gently. 

The  lower  lid  may  be  everted  by  drawing  it  down,  the 
patient  being  directed  to  look  upward. 


Fig.  45. — Method  of  everting  the  upper  eyelid.  {J.  P.  C.  Griffith.) 

Lime  splashed  in  the  eye  should  be  first  thoroughly 
washed  out  with  warm  water  and  bland  oil,  such  as  olive 
oil  dropped  in,  if  the  pain  continues.  A teaspoonful  of 
vinegar  added  to  a glass  of  the  water  used  for  washing 
the  eye  will  help. 

Fractures  are  of  different  kinds.  A fracture  is  a 
broken  bone.  In  simple  fracture  the  bone  is  broken  but 
there  is  no  external  wound. 

A compound  fracture  is  more  serious  because  there  is, 
besides  a fracture,  an  open  wound  through  which  germs 
may  enter.  Blood  posioning  frequently  results  in  cases 
of  this  kind.  Therefore  it  is  highly  important  to  keep 
such  a wound  as  clean  as  possible  from  the  beginning. 

In  all  such  cases,  send  for  the  doctor  as  soon  as  possible. 
Support  the  injured  part  by  the  use  of  splints.  If  the 
patient  has  to  l)e  moved  any  great  distance  bandage  a 
pillow  around  the  fracture  with  two  or  three  pieces  of 


ACCIDENTS  AND  EMEBGENCIES 


187 


board  outside  the  pillow  as  supporting  splints.  Always 
remember  that  a simple  fracture  may  be  made  a com- 
pound fracture  and  a much  more  serious  accident  by 
improper  handling 

Poisoning. — The  general  practice  when  the  cause  of 
the  poisoning  is  unknown  is  to  remove  the  unabsorbed 
poison  as  quickly  as  possible  from  the  system  by  the  use 
of  emetics  and  quick  acting  cathartics;  to  counteract  the 
depression  or  shock  by  heat,  stimulants,  etc.,  and  to 
relieve  the  pain  by  the  administration  of  quieting  medi- 
cines and  soothing  drinks. 

Emetics  are  substances  that  cause  vomiting.  Those 
obtainable  in  the  average  home  are: 

Tepid  water — two  to  four  glasses. 

Salt  solution  freely,  given  warm,  using  as  much  salt 
as  the  water  will  dissolve. 

Alum  (powdered)  may  be  given  in  1/2  teaspoonful 
doses  for  a child  and  a teaspoonful  for  an  adult.  Mix 
well  with  honey  or  syrup. 

Mustard  is  given  in  doses  of  from  1/2  to  1 teaspoonful 
for  a child  and  double  the  quantity  for  an  adult  stirred 
in  a glass  of  warm  water  and  quickly  swallowed.  It 
may  be  followed  with  copious  drinking  of  tepid  water. 

Stimulants  used  are  aromatic  spirits  of  ammonia,  1/2  to 
1 teaspoonful  in  water;  brandy,  or  whiskey  in  doses  of 
from  two  to  four  teaspoonfuls;  strong  tea  or  coffee;  hot 
and  cold  douches  alternately.  If  the  patient  cannot 
swallow  give  a stimulating  injection  into  the  rectum.  A 
cupful  of  black  coffee  may  be  given  by  rectum. 

Demulcents  are  soothing  substances  which  relieve  the 
internal  irritation  and  pain.  Among  these  are  milk, 
white  of  egg  and  milk,  flour  and  water,  arrowroot,  flax- 
seed tea,  olive  oil  and  gruel. 

Food  Poisoning j (Ptomaine  Poisoning). — The  promi- 
nent symptoms  are  usually  those  of  acute  inflammation 
of  the  stomach  and  bowels,  agonizing  pains,  cold  sweats, 
sometimes  chills  and  extreme  prostration.  In  meat  or 
fish  poisoning  occurring  as  the  result  of  putrefactive 


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changes  In  the  food,  the  change  may  be  imperceptible  to 
the  individual.  It  occurs  frequently  in  canned  goods  as 
the  result  of  chemical  action  on  the  food  from  the  tin. 
Foods  cooked  and  allowed  to  stand  in  brass  or  copper 
vessels  have  caused  severe  poisoning  and  death.  One  of 
the  common  forms  of  ptomaine  poisoning  is  by  ice  cream 
made  in  large  quantities  and  kept  in  unsanitary  condi- 
tions. 

To  get  the  offending  substance  out  of  the  system  is  the 
first  step.  Washing  out  the  stomach,  castor  oil  by 
mouth,  and  irrigation  of  the  bowel  are  among  the  com- 
mon measures  used  to  relieve. 

Poisoning  by  Inhaling  Gas, — The  first  thing  is  to  re- 
move the  patient  from  the  poisoned  air  as  rapidly  as 
possible.  Use  artificial  respiration  as  described  under 
^^drowming^’  (page  183)  if  necessary  to  start  breathing. 
Alcoholic  stimulation  by  mouth  and  an  injection  of  salt 
solution  into  the  rectum  may  be  used  if  the  condition  is 
serious.  Treatment  must  be  persisted  in  for  some  time 
in  many  cases  before  a reaction  from  the  effects  of  the 
poisoning  occurs. 


HOUSEHOLD  ANTIDOTES.  ^ 


For  bedbug  poison 

For  corrosive  sublimate.  . . 

For  blue  vitrol 

For  lead- water 

For  saltpeter 

For  sugar  of  lead 

For  sulphate  of  zinc 

For  red  precipitate 

For  vermilion 


Give  milk  or  white  of  eggs,  large 
quantities. 


For  Fowler’s  solution, 
For  white  precipitate. 
For  arsenic 

For  antimonial  wine. 
For  tartar  emetic .... 


}Give  prompt  emetic  of  mustard  and 
salt,  tablespoonful  of  each;  follow 
with  sweet  oil,  butter,  or  milk. 

(Drink  warm  water  to  encourage 
vomiting.  If  vomiting  does  not 
stop,  give  1 grain  of  opium  in  the 
water. 


^ Table  of  Household  Antidotes,  quoted  from  Pocket  Cyclopedia  of  Medicine 
and  Surgery,  Gould  and  Pyle. 


ACCIDENTS  AND  EMERGENCIES 


189 


For  oil  of  vitriol 

For  aqua  fortis 

For  bicarbonate  of  potash. 

For  muriatic  acid 

For  oxalic  acid 

For  caustic  soda 

For  caustic  potash 

For  volatile  alkali 

For  carbolic  acid 

For  chloral  hydrate 

For  chloroform 

For  carbonate  of  soda 

For  copperas 

For  cobalt 


Magnesia  or  soap,  dissolved  in  water, 
every  two  minutes.  For  oxalic 
> acid,  give  calcium  carbonate  or  hy- 
drate (lime-water,  chalk,  wall- 
plaster,  in  water). 

I Drink  freely  of  water  with  vinegar  or 
j lemon  juice  in  it. 

1 Give  flour  and  water,  glutinous  drinks 
/ and  a form  of  alcohol. 

}Pour  cold  water  over  the  head  and 
face,  with  artificial  respiration;  gal- 
vanic battery. 

} Prompt  emetics;  soap  or  mucilagin- 
ous drinks. 


For  laudanum I Strong  coffee,  followed  by  ground 

For  morphin > mustard  or  grease  in  warm  water  to 

For  opium J produce  vomiting.  Keep  in  motion. 


For  nitrate  of  silver 

For  strychnin 

For  tincture  of  nux  vomica. 

For  iodine  and  iodides  .... 


Give  common  salt  in  water.  Emetic 
of  mustard  or  sulphate  of  zinc, 
aided  by  warm  water. 

Prompt  emetic;  solution  of  starch, 
flour  and  water. 


Points  to  be  Remembered. — To  keep  a wound  clean  is 
one  of  the  most  important  duties. 

Direct  pressure  is  one  of  the  most  effective  methods  of 
checking  excessive  bleeding. 

If  a torniquet  or  tight  bandage  around  a limb  is  neces- 
sary, do  not  leave  it  on  too  long  or  serious  results 
may  follow.  It  is  better  to  remove  it  after  two  hours 
and  if  the  bleeding  commences  again  to  reapply  the 
pressure. 

Be  sure  that  your  hands  are  clean  before  touching  a 
wound.  Take  time  to  scour  them  thoroughly  with  soap 
and  water  if  possible. 

Stimulants  tend  to  increase  the  flow  of  blood  and  should 
be  used  with  great  caution. 

The  dirt  that  gets  underneath  finger-nails  may  cause 
blood  poisoning  if  it  gets  into  a wound. 


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When  removing  a dressing  a little  carelessness  may 
tear  the  wound  open  and  undo  the  healing. 

In  serious  burns  the  danger  is  usually  in  proportion 
to  the  area  involved.  Shock  is  always  to  be  feared  in 
serious  burns.  It  is  easy  for  an  extensive  burn  to  become 
infected  and  blood  poisoning  may  develop  even  after  the 
first  danger  is  past. 

In  case  of  freezing,  always  be  sure  that  the  tempera- 
ture of  the  room  in  which  the  patient  is  placed  is  slowly 
and  gradually  raised. 

Sprains  require  time  for  the  injured  tissues  to  recover 
and  patience  is  very  necessary. 

Every  home  nurse  should  know  the  substances  which 
can  be  used  in  an  emergency  to  quickly  empty  the  stom- 
ach and  be  quick  to  use  them  when  necessity  arises. 

Many  deaths  occur  every  year  from  children  acci- 
dentally drinking  lye,  carbolic  acid,  laudanum,  or  other 
poisonous  substance.  Prompt  use  of  an  emetic  may 
save  a life. 

In  all  forms  of  food  poisoning,  cholera  morbus,  etc.,  the 
first  and  most  important  thing  is  to  get  the  offending 
substance  out  of  the  body  as  quickly  as  possible.  Even 
if  diarrhea  is  present  a dose  of  castor  oil  should  be  given 
to  quickly  clear  out  the  food  tract. 

REVIEW  QUESTIONS. 

1.  State  the  first  aid  methods  that  should  be  used  in  case  of 
wounds. 

2.  AVhat  measures  would  you  use  to  check  excessive  bleeding  from 
the  arm?  From  the  head? 

3.  In  case  of  excessive  bleeding  from  the  nose  what  should  be 
done  to  relieve  it  ? 

4.  What  is  a torniquet?  A\Tiat  precautions  should  be  observed 
in  using  it? 

5.  How  would  you  disinfect  your  hands  before  dressing  a wound  ? 

6.  Outline  the  emergency  management  of  a superifical  burn  of 
extensive  area. 

7.  What  should  be  done  if  the  clothing  gets  on  fire  ? 

8.  When  fainting  occurs  what  should  be  the  first  aid  measures? 


ACCIDENTS  AND  EMERGENCIES 


191 


9.  Distinguish  between  heat  exhaustion  and  heat-stroke  and 
state  how  each  condition  should  be  managed. 

10.  Outline  the  nursing  measures  that  should  be  used  in  case  of 
sprains. 

11.  What  are  emetics?  Name  some  substances  which  may  be 
used  as  emetics. 

12.  Outline  the  general  methods  used  in  case  of  poison  being 
accidentally  swallowed  by  mouth. 

13.  How  would  you  deal  with  a case  of  food  poisoning  till  the 
doctor  could  be  secured? 

14.  In  a case  of  poisoning  by  illuminating  gas  what  methods  would 
you  use  to  restore  ? 


NOTES  ON  SOME  COMMON  DISEASES  AND 
CONDITIONS. 


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CHAPTER  XXII. 


MATERNITY  NURSING. 

Demonstration  and  Practice  Work. — Care  of  depressed  nipples; 
preparation  of  vulva  pads;  preparation  of  room  and  bed  for  a 
birth;  methods  of  preventing  hemorrhage  after  childbirth. 

Whether  or  not  the  average  woman  or  girl  ever 
expects  to  do  nursing  outside  of  her  own  family  circle, 
she  should  seek  intelligent  practical  information  re- 
garding the  care  which  should  be  given  to  a woman  be- 
fore, during,  and  after  childbirth,  and  the  care  of  the 
new-born  infant.  This  form  of  illness  is  one  that  prac- 
tically every  woman  encounters  at  some  time.  Every 
community  has  its  traditions  regarding  the  care  that 
should  be  exercised,  and  there  is  no  lack  of  women  who 
regard  themselves  as  competent  to  advise  the  expectant 
mother.  The  mother  of  eleven  who  has  buried  seven 
is  more  than  likely  to  regard  herself  as  a walking  encyclo- 
pedia of  maternity  wisdom.  When  there  are  reasons  for 
believing  that  a baby  is  to  be  expected  it  is  wise  to  con- 
sult the  most  reliable  physician  available  and  act  on  his 
advice  rather  than  the  neighbors^  suggestions. 

BEFORE  THE  BABY  COMES. 

The  care  which  a pregnant  woman  gives  herself  or  has 
given  her  by  others  has  an  exceedingly  important  bearing 
on  the  child^s  welfare  as  well  as  her  own.  Greater  care 
than  usual  should  be  exercised  to  observe  be  common 
laws  of  health  and  keep  the  functions  normal  as  far  as 
possible. 

Diet. — Most  pregnant  women  suffer  from  constipation 
to  a greater  or  less  degree.  Occasionally  diarrhea  recurs 

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again  and  again.  Since  the  mother  must  not  only  eat 
for  two  but  excrete  for  two  as  well,  it  is  most  important 
that  the  digestive  system  and  excretory  organs  be  kept 
in  as  good  condition  as  possible.  De  Lee  recommends 
for  the  relief  of  constipation  the  establishing  of  regular 
habits  of  attempting  to  empty  the  bowel,  the  use  of  laxa- 
tive fruits,  and  a glass  of  cold  water  on  rising  in  the 
morning  and  at  bedtime;  the  abandonment  of  tea,  and  a 
diet  containing  fruits  and  vegetables  in  abundance,  espe- 
cially spinach,  peas,  beans,  barley,  tomatoes,  corn,  and 
foods  of  this  kind.  Davis  advises  a diet  based  mainly  on 
milk,  bread,  and  fruit.  Most  authorities  advise  that  very 
little  meat  be  used,  and  many  prohibit  beef  entirely  in 
the  last  three  months,  and  earlier,  if  the  kidneys  seem  to 
be  performing  their  functions  imperfectly.  The  chief 
reason  for  advising  the  curtailment  in  the  amount  of  meat 
is  because  of  the  extra  burdens  always  thrown  on  the  kid- 
neys in  this  period.  Meat  not  more  than  once  a day  is 
a good  rule  for  anybody,  and  especially  desirable  in  the 
case  of  pregnant  women.  Wilson  suggests  the  use  of  fish, 
oysters,  lamb,  fowl,  salt  meat,  and  eggs  in  moderation  in 
normal  cases.  AVhen  morning  sickness  interferes  with 
appetite  and  digestion  in  the  early  stages  it  is  necessary 
that  the  patient  take  food  at  irregular  hours.  While  that 
distressing  period  lasts  it  is  wise  to  cater  to  the  appetite 
within  reasonable  limits.  The  longing  or  craving  for  cer- 
tain articles  of  food,  if  these  are  not  likely  to  upset  or 
interfere  with  the  digestive  functions,  may  be  gratified, 
but  rich  foods,  pastry,  fried  stuff,  pickles,  and  sweets  in 
excess  are  better  avoided. 

Clothing. — Most  women  need  some  caution  along  this 
line.  As  far  as  possible  all  clothing  should  be  suspended 
from  the  shoulders,  and  pressure  of  any  kind  on  the 
abdomen  avoided.  The  lungs  should  be  given  plenty  of 
room  to  expand.  Because  of  the  tendency  of  some  wo- 
men to  varicose  veins,  pressure  from  circular  garters 
should  also  be  avoided. 

Exercise  is  exceedingly  necessary  to  the  welfare  of  the 


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pregnant  woman.  It  should  never  be  violent,  and  should 
stop  short  of  fatigue.  It  is  just  as  well  to  avoid  exercise 
which  requires  much  upward  stretching  of  the  arms. 
Bicycle  or  horseback  riding,  or  running  a sewing  machine 
for  hours  at  a time,  are  not  advisable. 

Baths  are  needed  for  cleanliness,  comfort,  and  health, 
but  cold  baths  should  not  be  taken.  Hot  baths  also  are 
best  omitted,  especially  in  the  later  months. 

The  urine  needs  to  be  constantly  observed  as  to  quan- 
tity and  general  character.  Where  constipation  exists, 
extra  burdens  are  thrown  on  the  kidneys.  After  the 
fifth  month  frequent  and  regular  examination  of  the 
urine  is  desirable,  and  for  this  reason  it  is  always  well  for 
the  pregnant  woman  to  decide  early  on  the  physician 
she  desires  to  attend  her,  so  that  general  conditions 
may  be  under  observation  and  danger  signals  promptly 
recognized. 

Vaginal  discharges  should  be  inquired  for  at  intervals 
throughout  the  pregnancy.  There  is  usually  more  or  less 
leukorrhea.  Bleeding  from  the  vagina  has  special  sig- 
nificance. This,  and  any  signs  of  a purulent,  or  unusual 
or  offensive  discharge,  should  be  promptly  reported  to  the 
physician. 

The  nipples  should  receive  some  attention.  If  de- 
pressed, some  measures  may  be  used  to  draw  them  out, 
and  compression  should  be  avoided.  Authorities  vary  as 
to  the  necessity  or  value  of  applying  lotions  to  the  nipple. 
The  common  method  of  bathing  them  in  whiskey  or  alco- 
hol to  harden  them  is  condemned  by  most  modern  med- 
ical authorities,  who  say  the  nipple  should  rather  be  kept 
soft  and  pliable.  If  there  is  a physician  in  charge  he 
will  advise  regarding  this  point.  If  the  breasts  are  heavy 
they  should  be  supported  by  a binder. 

The  mental  condition  is  important.  As  far  as  can  be 
the  patient  should  be  protected  from  petty  irritations, 
shock,  or  worry.  Especially  is  it  desirable  that  well- 
meaning  friends  and  neighbors  are  not  allowed  to  fill  her 
mind  with  tales  of  coming  ills.  Such  patients  are  only 


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too  prone  to  become  ^^blue”  and  despondent,  and  all 
reasonable  means  should  be  used  to  combat  this  condition. 

Preparations  for  the  Birth. — Most  women  know  by  in- 
stinct or  observation  the  articles  for  the  baby’s  use  which 
will  be  needed.  Decisions  in  this  manner  are  always  influ- 
enced by  the  financial  condition  of  the  family,  and  ex- 
travagant preparations  should  never  be  advised.  The 
list  of  articles  below  will  be  possible  for  even  those  in 
very  moderate  financial  circumstances  to  secure,  and  can 
be  added  to  as  can  be  afforded: 

Three  flannel  bands,  6 ins.  wide  by  18  ins.  long.  (Edges 
should  be  torn  and  not  hemmed.) 

Three  shirts  (long  sleeves)  of  cotton  and  wool. 

Three  petticoats  with  sleeveless  waists. 

Three  soft  linen  towels. 

Three  to  six  dresses  of  oufing  flannel  or  lawn,  according 
to  time  of  year.  Night  gowns  if  desired. 

Two  to  three  dozen  light-weight  cotton  diapers,  which 
should  be  washed  well,  rinsed,  and  ironed  before  using. 

Besides  these  it  will  save  much  washing  if  three  or  four 
dozen  or  more  12-inch  squares  of  clean  old  linen  be  pro- 
vided, which  can  be  used  inside  the  diaper  and  burned 
after  use. 

A couple  of  little  quilted  pads  of  cheese  cloth  or  soft 
cotton  with  a layer  of  cotton  batting  are  often  provided 
to  slip  between  the  diaper  and  skirts,  and  are  a great  help 
in  keeping  the  clothing  dry. 

Two  little  comforts,  made  of  thin  white  outing  flannel 
or  cheese-cloth  and  cotton  batting,  are  useful  to  wrap  the 
baby  in.  About  a yard  and  a half  square  is  a good  size. 
A piece  of  old  clean  blanket  or  flannel  to  receive  the  child 
at  birth  will  be  needed. 

A much  appreciated  convenience  is  a flannel  bath 
apron.  Inside  the  center  half  is  tacked  a strip  of  oil- 
cloth or  rubber  about  a half  yard  wide.  Most  young 
mothers  will  be  glad  to  provide  this,  which  will  be 
useful  during  the  baby’s  bath  hour  as  long  as  needed. 
The  nurse  will  find  it  saves  much  washing  of  aprons. 


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201 


Four  ounces  of  olive  oil;  a rubber  sheet  or  new  oil- 
cloth to  protect  the  mattress;  one  new  hand  basin  of 
enameled  ware.  To  this  list  may  be  added  the  things 
usually  contained  in  a baby’s  toilet  basket — a cake  of 
white  castile  soap,  soft  washcloths  for  body  and  mouth, 
talcum  powder,  plenty  of  safety  pins,  large  and  small; 
common  pins,  vaselin. 

The  following  general  supplies  are  desirable  for  the 
prospective  mother  to  provide  if  possible: 

One  4-ounce  bottle  of  carbolic  acid. 

One  4-ounce  bottle  of  alcohol. 

One-half  pound  boric  acid  powder. 

One-fourth  pound  of  absorbent  cotton. 

One  bed-pan. 

One  small  granite  basin  holding  about  a quart. 

Two  quart  bottles  or  jars  for  carbolic  and  boric  acid 
solutions. 

Sufficient  bedding  and  towels  to  allow  for  a change 
once  in  two  days. 

Two  or  three  quilted  cotton  hip  pads  for  the  bed  made 
about  1/2  yard  by  a yard  are  most  useful  in  preventing 
soiling  of  the  sheets  during  the  whole  confinement. 
Afterward  they  can  be  used  for  the  baby’s  basket  or  crib. 

During  the  first  week  it  is  necessary  to  change  the 
vulva  pads  or  napkins  worn  by  the  mother,  about  every 
four  hours.  In  order  to  save  washing  and  also  to  prevent 
infection  it  is  wise  for  the  expectant  mother  to  provide 
about  three  dozen  pads  made  of  cheese  cloth  and  cotton 
batting  or  absorbent  cotton.  These  pads  may  be  made 
from  old  soft  clean  sheets  or  night  gowns  if  these  are  to  be 
had.  They  should  be  made  about  12  to  18  inches  long 
and  4 wide  when  finished,  the  padding  to  be  about  an 
inch  thick.  A layer  of  absorbent  cotton  on  a layer  of 
cotton  batting  makes  a good  pad.  If  cheese  cloth  is 
used  it  should  be  boiled  in  soap  and  water,  well  rinsed, 
dried  and  ironed,  before  making  it  up. 

When  the  pads  are  made,  pin  them  up  in  packages  of 
one  dozen  each,  wrap  them  in  a piece  of  cotton  or  thick 


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clean  paper,  and  bake  them  for  about  three-quarters  of 
an  hour  in  the  oven.  The  packages  are  then  laid  aside 
where  they  will  not  be  disturbed  or  opened,  till  needed 
after  the  baby  arrives. 

Preparations  for  Labor. — The  preparation  of  the 
patient  includes  a cleansing  bath,  an  enema  to  flush  the 
lower  bowel,  the  thorough  washing  of  the  vulva,  buttocks, 
lower  abdomen,  and  thighs  with  green  soap  and  water, 
and  afterward  with  an  antiseptic  solution.  A sterile  or 
antiseptic  vulva  pad  should  then  be  put  on  the  patient 
and  a clean  gown. 

In  olden  times  the  loss  of  life  from  child-bed  fever, 
so-called,  was  great.  It  took  mankind  a long  time  to 
discover  that  the  cause  of  the  trouble  was  that  infectious 
or  disease-producing  germs  were  somehow  carried  into 
the  blood  through  the  birth  canal  and  that  this  trouble 
was  preventable  if  reasonable  precautions  were  observed. 

It  is  important  for  the  nurse  to  remember  that  from 
the  beginning  of  the  case  of  labor  till  at  least  ten  days 
after  delivery  there  are  possibilities  of  infection  to  the 
patient.  Practically  no  birth  is  accomplished  without 
fissues  or  tears  of  some  kind  occurring  in  the  birth  canal. 
These  may  be  very  small,  but  the  possibility  of  infection 
is  there.  Besides,  there  is  the  large,  raw  surface  inside 
the  uterus  or  womb  from  which  the  placenta  or  ^^after- 
birth’’ has  separated  or  is  gradually  being  separated; 
therefore  the  reason  for  surgical  cleanliness  is  clear. 

Infection  may  take  place  from  the  clothing  of  the 
patient  or  bed;  from  the  hands  of  the  patient,  nurse,  or 
physician;  from  dressings;  from  water,  basins,  or  other 
appliances  used  al)out  the  delivery  room. 

The  bed  should  liave  the  mattress  protected  with  a rub- 
ber sheet  or  oil-cloth.  The  regulation  delivery  bed  has 
an  extra  delivery  rubber  and  sheet  placed  over  those  ordi- 
narily used  in  the  care  of  such  cases,  which  is  removed 
when  the  birth  is  concluded. 

"Hie  rooin  should  be  cleared  of  unnecessary  articles 
which  collect  dust  easily  and  require  to  be  dusted  fre- 


MATERNITY  NURSING 


203 


quently  or  moved  about.  It  should  be  clean,  well  venti- 
lated and  lighted,  and  moderately  warm.  Newspapers  or 
some  protection  for  the  carpet  should  be  made  before 
delivery  in  a private  home. 

Plenty  of  hot  boiled  water  is  always  needed.  Both  hot 
and  cold  water  should  be  provided  if  there  is  time.  Physi- 
cians differ  as  to  the  solutions  used,  but  usually  it  is  safe 
to  prepare  a half  gallon  of  corrosive  sublimate,  or  at 
least  to  have  the  water  ready  in  which  to  dissolve  the 
tablets.  The  boracic  acid  solution  also  may  be  prepared 
in  advance  of  the  physician^ s coming. 

A great  many  of  the  directions  given  may  seem  to  the 
untrained  woman  as  entirely  unnecessary.  It  is  true 
that  many  women  have  survived  after  bad  care.  Some 
women  have  an  unusually  strong  constitution  that  easily 
throws  off  disease  germs.  Others  have  not,  and  every 
community  has  had  enough  deaths  from  fever  develop- 
ing after  childbirth  to  show  clearly  the  dangers. 

A doctor  who  makes  a specialty  of  maternity  work  has 
arranged  a series  of  directions  on  a printed  slip  which  he 
gives  to  each  nurse  who  cares  for  his  patients  in  private 
homes.  The  following  directions  are  taken  from  this 
printed  slip: 

^^1.  When  labor  begins  give  patient  a large  enema  of 
soap  and  water.  Then  give  a general  bath.  Then  scrub 
the  genitals,  perineum,  lower  abdomen,  thighs,  and  but- 
tocks with  soft  soap  and  warm  water — using  a soft  brush. 
Wash  off  soap  with  boiled  water. 

^^2.  Then  the  nurse  should  disinfect  her  hands  as  fol- 
lows: (a)  Trim  finger-nails  short  and  clean  under  them. 
{b)  Scrub  hands  and  forearms  vigorously  with  brush,  soft 
soap,  and  warm  water — giving  special  attention  to  the 
irregularities  about  the  nails.  Rinse  off  the  soap  with 
boiled  water,  (c)  Then  scrub  them  in  bichloride  solution 
(1:1000)  with  a separate  brush  kept  for  that  purpose. 

^^3.  Then  wash  patient  (genitals,  lower  abdomen,  etc.), 
with  bichloride  solution  (1:1000),  using  absorbent  cot- 
ton, and  after  the  washing  cover  the  genitals  with  a thin 


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pad  of  absorbent  cotton  wrung  out  of  bichloride  solution 
(1:1000)  and  wipe  the  other  parts  dry  from  bichloride 
solution  with  a towel.  The  bichloride  pad  may  be  held 
in  place  by  a piece  of  gauze  fastened  to  a gauze  strip 
around  the  abdomen.  The  patient  may  then  sit  up  or 
walk  about  until  the  pains  become  severe  enough  to  con- 
fine her  to  bed. 

^^4.  When  any  manipulation  is  to  be  made  about  the 
genitals  (catheterization,  change  of  pad,  douche)  the 
hands  are  to  be  sterilized  as  above  directed,  and  after  the 
manipulation  the  pad  is  to  be  replaced  by  the  sterilized 
hand.  No  unsterilized  object — hand,  instrument,  or 
dressing — is  to  be  allowed  to  touch  the  genitals. 

^^5.  Immediately  after  the  child  is  born,  the  nurse  is 
to  place  one  hand  over  the  uterus  or  womb  and  keep  it 
there  until  the  binder  is  applied.  When  the  uterus  re- 
laxes it  is  to  be  gently  stimulated  to  contraction  by  the 
hand  placed  over  it.  After  the  placenta  has  been  ex- 
pelled and  the  hemorrhage  has  ceased,  the  genitals  are 
to  be  washed  off  with  bichloride  solution  (l.TOOO)  and 
the  dressing  applied  and  the  binder  put  on. 

^^6.  When  the  patient  wishes  to  urinate,  or  the  dressing 
has  to  be  changed  from  other  causes,  proceed  as  follows: 
(a)  Slip  bed-pan  under  patient,  remove  dressing,  and 
allow  patient  to  urinate,  (b)  Cleanse  hands  as  previously 
directed,  (c)  Wash  genitals  by  allowing  a warm  bi- 
chlorid  solution  (1:1000)  to  flow  gently  over  them,  and 
then  apply  a fresh  dressing  and  reapply  the  abdominal 
binder. 

7.  No  douche  is  to  be  given  except  by  special  order. 
The  patient  need  not  be  catheterized  unless  she  ex- 
periences difficulty  in  urinating  or  has  a severe  laceration. 
Catheters,  douche-nozzles,  and  everything  else  coming  in 
contact  with  the  genitals  must  pass  through  the  process 
of  sterilization  and  nothing  unsterilized  is  to  be  allowed  at 
any  time  to  touch  the  genitals. 

^^8.  As  soon  as  the  child  is  born,  before  the  cord  is  tied, 
and,  if  possible,  before  the  eyes  are  opened,  wipe  all  secre- 


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tions  from  the  lids  with  gauze  or  cotton  and  wash  the 
eyes  with  boric  acid  solution  (3  per  cent.)  or  boiled  water. 
After  the  baby  is  bathed,  wash  the  stump  of  the  cord  with 
bichloride  solution,  dust  boric  acid  powder  freely  about 
it,  and  apply  a dressing  of  bichloride  gauze.  After  that 
keep  the  cord  dry  by  frequently  dusting  boric  acid  powder 
freely  about  it.  Do  not  remove  the  gauze  as  long  as  it 
remains  dry. 

^^9.  As  soon  as  the  mother  is  rested  after  labor,  that  is, 
within  six  to  twelve  hours,  the  baby  should  be  allowed  to 
nurse.  After  that,  until  a free  flow  of  milk  is  established, 
it  should  nurse  only  about  every  four  hours.  As  soon  as 
the  milk  flows  freely  the  baby  should  nurse  every  two 
hours,  from  5 a.  m.  to  11  p.  m.,  and  not  between  times, 
except  for  some  special  reason.  If  before  the  flow  of  milk 
is  well  established  the  child  becomes  restless  and  appar- 
ently hungry,  in  spite  of  nursing  its  mother,  it  may 
be  given  a small  amount  of  boiled  water  frequently, 
and  if  that  does  not  suflS.ce,  then  milk  prepared  as 
directed. 

10.  In  allowing  the  baby  to  nurse,  open  the  breast 
binder  and  wash  off  the  boric  acid  powder  with  a little 
boiled  water.  When  the  baby  has  finished  nursing, 
cleanse  the  nipples  with  the  boiled  water,  wipe  dry  and 
dust  over  them  boric  acid  powder  and  place  around  them 
a small  piece  of  cotton  and  reapply  the  breast  binder. 
If  nipples  are  tender,  wash  them  with  diluted  alcohol 
after  each  nursing.  Keep  the  baby  in  crib  except  when 
nursing.^’ 

The  nurse^s  duties  differ  under  different  conditions  and 
at  different  stages.  If  she  arrives  before  the  physician 
has  been  called  she  can  report  to  him  her  observation  as 
to  character  and  frequency  of  the  pains,  and  whether 
other  signs  of  labor  are  present.  She  will,  of  course,  be 
expected  to  prepare  the  patient  and  room,  to  assist  the 
physician  in  every  way  possible,  and  render  such  assist- 
ance to  the  patient  as  she  can.  What  can  the  nurse  do  to 
render  labor  more  tolerable  for  the  patient  is  a question 


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often  asked?  Sometimes  rubbing  or  pressure  on  the 
lower  part  of  the  back  during  a pain  seems  to  afford  relief. 
Occasionally  a cramped  limb  can  be  rubbed  and  relieved. 
In  the  first  stage  a change  of  position  can  be  suggested. 
Many  patients  are  loath  to  change  position  lest  their  pains 
increase.  Exhaustion  of  strength  by  useless  thrashing 
around  in  bed  can  be  prevented.  Light  nourishment  in 
the  early  stages  of  labor  is  permissible.  If  difficulty  is 
experienced  in  voiding  urine  the  catheter  should  be  used. 
A distended  bladder  may  retard  progress.  It  is  a mis- 
take for  the  nurse  to  allow  the  patient  to  drag  on  her  arms 
in  the  bearing-down  efforts,  especially  if  the  labor  is 
protracted.  Other  mechanical  means  can  be  provided. 
In  the  last  few  expulsive  pains  firmly  gripping  of  the 
patient’s  hands  will  help  the  patient  and  not  unduly 
exhaust  the  nurse.  In  all  cases  the  nurse  can  give 
sympathy,  encouragement,  and  moral  support. 

Points  to  be  Remembered. — A good  deal  of  trouble  can 
be  avoided  by  proper  care  of  the  expectant  mother 
before  the  baby  comes. 

Very  little  meat  in  the  diet  is  a good  rule. 

Tight  garters  and  bands  should  be  avoided  especially 
in  the  later  months. 

Consult  the  doctor  not  later  than  the  fifth  or  sixth 
month — earlier  if  there  are  any  unfavorable  symptoms. 

As  a general  rule  unless  the  nipples  are  flat  or  depressed 
very  little  attention  to  them  is  needed  before  the  baby 
comes. 

Lying-in  women  are  especially  liable  to  infection. 

Remember  that  it  is  the  unseen  dirt — the  germs  too 
small  to  be  seen — which  usually  cause  the  trouble  in 
such  cases. 

Nothing  is  small  enough  to  be  careless  about  in  caring 
for  such  patients. 

A careless  nurse  with  unclean  hands  may  easily  infect 
a maternity  patient. 

Proper  case  of  the  baby’s  eyes  is  an  important  duty 
during  and  immediately  after  birth. 


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Always  wash  the  hands  thoroughly  before  changing 
the  pads  of  the  mother. 

REVIEW  QUESTIONS. 

1.  What  advice  regarding  her  own  health  would  you  give  to  a 
prospective  mother? 

2.  What  if  any  changes  in  clothing  would  you  recommend  ? 

3.  Give  reasons  why  it  is  important  to  have  the  urine  examined 
at  frequent  intervals. 

4.  Outline  some  recommendations  in  regard  to  the  breasts  and 
nipples  before  the  birth. 

5.  What  recommendations  would  you  make  regarding  napkins 
or  pads  for  the  mother  and  why  ? 

6.  How  would  you  prepare  the  patient  for  labor  ? What  prep- 
aration would  you  make  regarding  the  bed  and  the  room  ? 

7.  How  may  child-bed  fever be  caused  and  what  preventive 
measures  would  you  use  ? 

8.  How  may  infection  take  place  under  such  conditions  ? 

9.  Write  a synopsis  of  the  directions  given  for  the  guidance  of  the 
nurse  in  general  care  of  the  patients  ? 

10.  What  can  a nurse  do  to  render  labor  more  tolerable  for  the 
patient  ? 


CHAPTER  XXIII. 


MATERNITY  NURSING  AFTER  THE  BIRTH. 

Demonstration  and  Practice  Work. — Application  of  abdominal 
and  breast  binders.  Use  and  care  of  breast  pump  and  nipple  shield. 
How  to  massage  breasts.  Preparation  of  menus  for  first  five  days 
after  birth.  Bathing  and  dressing  new-born  baby.  Care  of  cord. 
Irrigation  of  baby’s  eyes. 

After  the  birth  as  a rule  six  weeks  elapse  before  the 
patient  may  be  considered  to  have  entirely  recovered. 
Often  this  period  extends  to  three  months. 

Involution  is  the  return  of  the  womb  to  its  normal  size 
after  the  birth.  If  abnormal  conditions  develop  the 
process  of  involution  may  be  incomplete  and  the  womb 
remain  permanently  enlarged.  This  condition  is  termed 
subinvolution.  During  the  period  of  involution  the  lining 
membrane  of  the  uterus  and  other  tissues  no  longer 
needed  are  cast  off  and  a new  lining  is  formed. 

The  lochia  is  the  term  given  to  the  discharge  from  the 
vagina  in  the  first  few  weeks  following  child-birth.  This 
discharge  is  first  bloody.  Besides  the  discharge  from  the 
uterus,  there  may  be  blood  from  slight  lacerations  in 
the  vagina.  The  bloody  discharge  in  three  or  four  days 
gives  place  to  a watery  pinkish  discharge.  After  the 
eighth  or  ninth  day  the  lochia  becomes  pale,  almost 
white,  and  is  more  like  mucus  in  character.  The  lochia 
has  a characteristic  odor  of  its  own  from  the  beginning, 
but  the  normal  odor  is  never  offensive. 

Any  sign  of  an  offensive  odor  or  special  change  m the 
discharge  should  be  reported  to  the  physician.  It  may 
be  caused  by  retained  l)lood-clots  which  are  decomposing 
in  the  uterus,  or  l)y  retained  membranes  or  placenta. 
All  these  conditions  require  attention.  The  presence  of 
large  blood-clots  in  the  discharge  should  be  reported. 

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209 


The  First  Day. — After  the  mother  has  been  made  com- 
fortable following  the  birth  the  most  immediate  neces- 
sity for  her  is  rest.  A hot  drink  of  some  kind  may  be 
given  her.  Then  the  room  should  be  darkened  and  she 
be  allowed  to  rest  or  sleep  for  a few  hours.  Careful 
watch  must  be  made  all  through  the  first  day  for  signs  of 
hemorrhage.  The  temperature  and  pulse  should  be 
noted  before  she  goes  to  sleep  and  about  every  four  hours 
unless  she  is  sleeping. 

Before  changing  the  vulva  pads  the  hands  should  be 
disinfected.  If  there  are  stitches  in  a lacerated  peri- 
neum these  require  special  attention.  The  same  surg- 
ical precautions  are  needed  as  in  dressing  a wound.  The 
puerperal  woman  is  a surgical  case  with  wounds,  visible 
or  invisible,  is  ready  to  receive  infection.  The  vulva 
pads  for  the  first  day  should  be  changed  every  three,  or 
at  most  four  hours.  (For  the  next  four  or  five  days  a 
change  of  pads  about  every  four  hours  should  be  made. 
Then  the  discharge  has  lessened,  so  that  once  in  six 
hours  should  be  sufficient.) 

The  diet  for  the  first  day  should  be  mostly  liquid, 
though  in  a normal  case  toast  or  some  other  light  nourish- 
ment may  be  added  if  the  patient  seems  hungry.  This 
will  depend  somewhat  on  how  long  or  exhausting  the 
labor  has  been,  and  the  general  condition  and  appetite 
of  the  patient.  There  is  no  special  reason  for  starving  a 
patient  at  this  time. 

The  colostrum  is  the  name  given  to  the  milk  contained 
in  the  mothers  breast  at  and  immediately  following  de- 
livery. It  is  a thin  fluid,  saline  and  laxative  in  character, 
and  not  very  nutritious.  The  baby  needs  just  this 
laxative,  and  when  the  mother  has  rested  the  baby 
should  be  put  to  the  breast  and  encouraged  to  nurse. 
This  not  only  helps  to  stimulate  the  baby’s  bowels, 
but  also  promotes  contraction  of  the  uterus,  stimulates 
the  secretion  of  milk,  and  helps  to  draw  out  the  nipple. 

Cleanliness  and  Neatness. — A nurse  may  be  very  care- 
ful in  observing  the  rules  for  surgical  cleanliness  and  yet 
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be  a very  untidy  obstetric  nurse.  Wilson  says,  ^Hhe 
efficiency  and  thoroughness  of  a nurse  are  often  judged 
by  the  cleanliness  in  which  she  keeps  her  patient.  A 
soiled  bed  and  unclean  vulva  pads  may  be  the  measure 
of  the  nurse^s  indifference  to  the  proper  care  of  her 
patient.^^  The  criticism  of  untidiness  is  often  made  about 
maternity  nurses.  There  are  so  many  little  things 
which  can  be  left  lying  around  the  lying-in  chamber, 
and  some  nurses  seem  to  be  blissfully  oblivious  to  an 
untidy  room.  They  have  evidently  never  formed  the 
habit  of  having  a place  for  everything  and  keeping  it  in 
its  place  when  it  is  not  in  actual  use.  Order  is  quite 
possible  in  the  average  sick-room,  and  the  home  nurse 
who  fails  to  secure  it  fails  of  her  highest  success  as  a 
nurse. 

The  Catheter. — To  catheterize  or  not  is  a question  that 
often  presents  itself  in  the  first  day  or  two  following  de- 
livery. There  has  been  much  bruising  and  stretching  of 
the  parts.  The  urethra  has  been  drawn  from  its  normal 
position,  and  more  or  less  swelling  of  the  vulva  is  usually 
present.  Unless  the  patient  is  suffering  and  unable  to 
urinate,  twelve  hours  or  even  longer  may  be  allowed  to 
pass  before  trying  to  have  the  bladder  emptied.  Most 
physicians  prefer  that  the  catheter  be  not  used  unless  it 
becomes  an  absolute  necessity.  Before  resorting  to  its 
use  several  other  methods  to  induce  urination  should  be 
tried.  Some  patients  from  sheer  nervousness  cannot 
relax  to  empty  the  bladder  if  anyone  is  present.  See 
page  225. 

The  Obstetric  Binder. — The  usefulness  or  uselessness 
of  the  abdominal  binder  during  the  period  after  child- 
birth is  a question  on  which  many  conflicting  opinions 
exist.  A great  many  physicians  advise  using  one  during 
the  first  forty-eight  hours.  Others  recommend  its  use 
only  for  the  first  few  days  after  the  patient  gets  out  pf 
])ed,  while  the  latter  procedure  is  regarded  as  useless  by 
many  eminent  physicians.  In  general  when  its  use  is 
recommended  it  is  for  one  of  three  purposes: 


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211 


To  aid  in  preventing  relaxation  of  the  womb. 

To  support  the  abdominal  muscles. 

To  promote  the  comfort  of  the  patient. 

This  latter  point  is  the  one  considered  by  probably  the 
majority  of  the  physicians.  When  used  to  prevent  hem- 
orrhage a folded  towel  is  placed  underneath  it,  directly 
over  the  upper  part  of  the  womb.  Too  great  pressure  is 
not  desirable,  and  has  been  assigned  as  a cause  for  back- 
ward displacement  of  the  womb.  Neither  is  a loose- 
fitting  binder  to  be  recommended.  If  used  at  all  it 
should  be  snugly  adjusted,  and  will  need  frequent  tight- 
ening as  the  uterus  contracts.  Unless  a nurse  will  prop- 
erly adjust  a binder  and  keep  it  adjusted  it  is  of  very  little 
use,  and  might  as  well  be  discarded.  It  should  not  reach 
too  high,  should  not  be  allowed  to  ^^ride  up’^  over  the  hip 
bones,  and  needs  to  be  changed,  as  a rule,  every  day.  In 
pinning  a binder  it  is  customary  to  begin  pinning  at  the 
middle,  pinning  downward  first,  and  then  upward.  Side 
gores  should  be  made  with  the  pins  so  that  it  fits  snugly. 
It  is  better  when  possible  to  have  the  binders  made  with 
a curve  in  the  back,  to  prevent  soiling. 

The  Care  of  the  Breasts. — Lactation  is  the  term  applied 
to  the  period  in, which  the  mother  nurses  the  child.  It 
terminates  with  the  weaning.  Before  and  after  each  nurs- 
ing the  nipple  is  washed  with  a saturated  solution  of  boric 
acid.  This  solution  should  be  kept  in  a convenient-sized 
bottle  and  never  allowed  to  stand  in  an  open  glass,  as  is 
so  frequently  seen.  Solutions  handled  in  this  careless 
way  are  apt  to  apply  as  many  germs  to  the  nipple  as  they 
remove.  If  there  is  tenderness  of  the  nipple  some  simple 
antiseptic  ointment  or  sterile  albolene  or  olive  oil  are 
often  ordered.  Sometimes  a breast  binder  is  necessary  if 
the  breasts  are  large  and  heavy.  Davis  says,  the  test  of 
the  value  of  a breast  binder  is  the  comfort  which  it  gives 
the  patient.  It  should  hold  the  breasts  gently  but  firmly, 
raising  them  and  drawing  them  inward  toward  the  middle 
line.^^  If  cracks  or  abrasions  appear,  or  the  patient  com- 
plains of  soreness  of  the  nipples,  it  is  a wise  precaution 


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to  keep  them  covered  with  sterile  gauze.  Some  physi- 
cians recommend  the  use  of  cotton  pledgets  on  tooth- 
picks when  washing  the  nipples  as  a preventive  of  in- 
fection, thus  avoiding  possible  infection  from  the  fingers. 
A breast-pump  should  not  be  used  unless  the  physician 
orders  it,  nor  should  the  breasts  be  massaged  or  rubbed 
without  an  order,  as  a general  rule.  If  a nipple  shield 
is  used  it  should  be  sterilized  by  boiling  twice  a day, 
washed  after  using,  and  kept  in  clean  boric  acid  solution 
covered. 

After-pains  are,  as  a rule,  due  to  muscular  contraction 
as  the  uterus  returns  to  its  normal  size,  but  may  be  caused 
by  blood-clots  being  retained.  They  are  not  frequent 
after  the  first  baby,  but  are  sometimes  very  annoying  in 
later  cases.  Various  means  are  used  to  relieve.  Some- 
times letting  the  patient  sit  up  to  urinate  will  help  to 
dislodge  clots,  and  many  physicians  recommend  this  as 
a routine  practice  to  promote  drainage.  If  the  pains 
are  sufficiently  troublesome  to  prevent  the  patient  getting 
needed  sleep,  the  doctor’s  attention  should  be  called  to 
the  matter. 

Bathing. — The  general  rule  is  a bath  once  a day  for 
an  obstetric  patient,  with  at  least  a morning  and  evening 
bath  for  hands  and  face  besides.  The  patient’s  wishes  re- 
garding the  frequency  of  the  bath  should  be  considered, 
but  cleanliness  must  be  maintained.  The  hair  should  be 
combed  every  day. 

Bowels. — Constipation  is  a common,  almost  universal, 
experience  in  such  cases.  The  physician  will  usually 
order  any  medicine  that  is  to  be  given.  There  should,  as 
a rule,  be  a good  movement  within  forty-eight  hours  after 
the  birth,  and  each  day  thereafter. 

If  the  breasts  become  engorged  Epsom  salt  is  often  or- 
dered to  relieve  the  condition.  Otherwise  some  simple, 
nonirritating  laxative  is  given  (castor  oil  is  one  of  the 
l)est)  and  an  enema  as  may  be  needed.  Compound 
licorice  powder  or  a compound  cathartic  pill  are  common 
cathartics  in  these  cases. 


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213 


Visitors  are  more  difficult  to  control  in  this  form  of 
illness  than  in  almost  any  other.  As  a rule,  until  the 
mother  is  able  to  be  out  of  bed  the  fewer  outside  visitors 
admitted  the  better.  Such  patients  do  not  crave  visitors, 
as  the  baby  is  a source  of  never-failing  interest.  They 
are  easily  upset  and  excited,  and  rise  of  temperature, 
disturbance  in  the  flow  of  milk,  and  other  undesirable 
conditions  not  infrequently  result  from  bad  management 
of  the  problem  of  visitors.  The  physician  should  be 
consulted  before  visitors  are  admitted.  His  orders  will 
greatly  help  the  nurse  to  manage  this  matter  without 
offense  to  family  or  friends.  Letting  visitors  see  the 
baby  will  often  satisfy  them  and  do  no  harm. 

Getting  out  of  bed  is  a matter  for  the  doctor  to  decide. 
The  tenth  day  is  the  time  fixed  for  this  event  by  the 
laity,  but  many  physicians  prefer  to  keep  the  patient  in 
bed  the  full  two  weeks.  Much  depends  on  the  individual 
patient  and  her  condition.  A change  from  the  bed  to 
the  couch  can  usually  be  made  in  normal  cases  by  the 
tenth  day,  but  so  long  as  there  is  a free  reddish  discharge 
the  patient  should  not  be  upon  her  feet. 

The  nurse^s  reports  should  begin  with  the  labor  if  she 
is  present  at  that  time.  Time  of  stages  of  labor,  birth  of 
child,  sex,  and  weight  should  be  recorded.  If  stitches  are 
taken  these  should  be  noted.  Pulse,  temperature,  respi- 
ration, condition  of  bowels,  kidneys,  lochia,  breasts,  milk, 
time  of  nursing,  diet,  and  after-pains  should  be  observed 
and  recorded.  The  physician's  attention  should  be  called 
to  rise  in  temperature,  abnormal  pulse,  sleeplessness  or 
headache,  severe  after-pains,  changes  in  the  amount, 
odor,  or  general  character  of  the  lochia;  constipation, 
inability  to  urinate;  pain  or  special  tenderness  in  the 
abdomen  if  it  continues  for  any  length  of  time;  any  sore- 
ness of  breasts  or  nipples;  any  swelling  or  pain  in  the 
limbs;  any  tendency  to  chills  or  complaint  of  chilliness; 
any  special  change  in  the  flow  of  milk. 

Diet. — For  the  flrst  few  days  a light  diet  is  usually 
prescribed  for  such  patients.  Thompson  says,  ^Hhe 


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patient’s  own  appetite  is  a better  guide  for  feeding  than 
are  any  rules  as  to  the  exact  time  which  has  elapsed  since 
the  birth.  She  should  not  be  urged  to  take  foods  un- 
less greatly  exhausted,  and  the  stomach  must  not  be 
overloaded.  The  occurrence  of  fever  is  a contra-indica- 
tion for  giving  much  proteid  food  except  milk,  but  ex- 
treme exhaustion  without  febrile  reaction  demands  it.” 

The  flow  of  milk  should  modify  the  diet  to  some  extent. 
If  the  flow  is  very  great  and  the  breast  engorged  fluids 
should  be  restricted.  If  the  milk  secretion  is  deflcient 
nutritious  fluids  should  be  increased.  The  nurse  should 
remember  that  there  is  a possibility  of  increasing  the 
quantity  by  adversely  affecting  the  quality.  Giving  too 
much  water,  tea,  or  such  fluids  as  do  not  really  nourish  is 
equivalent  to  pumping  water  into  the  milk  pail  to  increase 
the  quantity  of  milk.  Buttermilk  is  one  of  the  best  fluids 
to  use  to  increase  the  flow  of  milk.  Gruel,  cocoa,  and 
broths  thickened  are  also  useful.  The  following  dietary 
is  arranged  not  to  be  followed  invariably  in  any  case, 
but  simply  as  a guide  or  suggestion  as  to  suitable  food 
and  variety: 

First  Day. 

Breakfast:  Zwieback. 

Cereal  and  cream  or  gruel.  Milk,  tea,  or  cocoa. 

Toast.  Poached  egg  in  milk. 

Coffee  or  tea.  Supper: 

Baked  rice  and  cream. 

Lunch  or  noon  meal:  Farina  jelly. 

Beef  broth.  Crackers.  Tea  or  hot  milk. 

Custard,  baked.  Buttered  toast. 


Second  Day. 


Breakfast: 

Cereal  and  cream. 

Toast.  Scrambled  eggs. 
Coffee,  milk,  or  cocoa. 

Lunch  or  noon  meal: 

Oyster  soup  and  crackers. 
Orange  jelly. 

Cocoa  or  milk. 

Toast  or  bread  and  butter. 


Supper: 

Chicken  or  beef  broth  with 
crackers. 

Milk  toast. 

Stewed  prunes  or  apple  sauce. 
Milk  or  cocoa,  bread  and 
butter. 


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Third  Day. 


Breakfast: 

Cereal  and  cream. 

Toast.  Soft  boiled  egg. 
Chipped  beef  or  sliced  bacon. 
Coffee  or  milk. 

Lunch  or  noon  meal: 

Noodle  soup  and  wafers. 
Baked  potato. 


Baked  sweet  apple. 

Bread  and  butter. 

Tea  or  coffee. 

Supper: 

Creamed  sweetbread. 

Bread  and  butter.  Prunewhip. 
Tea,  milk,  or,  cocoa. 


Fourth  Day. 

Tapioca  cream. 
Tea  or  cocoa. 
Bread  and  butter. 


Breakfast: 

Orange  or  grapes. 

Cereal  and  cream. 

Toast.  Creamed  beef. 
Coffee,  tea,  or  cocoa. 

Dinner: 

Baked  fish,  cream  sauce. 
Lamb  chops,  broiled. 

Baked  or  mashed  potatoes. 


Supper: 

Blanc  mange  or  boiled  rice. 
Buttered  toast. 

Creamed  oysters. 

Fruit. 

Bread,  butter,  and  tea. 


THE  NEW-BORN  INFANT. 

An  infant  is  termed  new-born  till  the  cord  by  which 
it  has  been  attached  to  its  mother  has  been  entirely  sepa- 
rated. At  the  time  of  birth  the  eyes  and  mouth  of  the 
infant  are  washed.  When  the  cord  is  severed  and  regular 
respiration  established  the  baby  is  received  by  the  nurse 
or  other  assistant  in  warm  flannel.  When  possible  it  is 
desirable  to  have  a warm  sterile  towel  first  wrapped  round 
the  infant  before  being  wrapped  in  the  flannel,  a preven- 
tive of  possible  infection  of  the  cord.  It  may  then  be  laid 
aside  in  a warm  place  till  the  mother  has  been  made  com- 
fortable. Care  should  be  observed  that  there  is  an  open- 
ing for  air  to  reach  the  child,  and  for  the  first  hour  or  two 
it  is  well  to  examine  the  cord  at  frequent  intervals  for 
hemorrhage.  If  flat  tape  has  been  used  for  ligating  the 
cord  there  is  more  danger  of  leakage,  and  the  loss  of  even 
a small  amount  of  blood  may  be  serious.  In  such  cases 
no  time  should  be  lost  in  tying  again  above  the  first 
ligature. 


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The  first  bath  may  very  properly  be  delayed  a few 
hours.  In  fact,  immediate  washing  is  condemned  by 
many  obsetricians.  Great  physiologic  changes  take 
place  in  the  little  being  in  the  first  few  hours  or  moments. 
The  lungs  unfold  and  the  respiratory  organs  begin  their 
functions.  Great  changes  in  the  circulatory  system 
take  place,  the  opening  between  the  auricles  of  the  heart 
closes,  and  the  blood  begins  to  follow  a different  course. 
The  blood  itself  undergoes  a change.  The  kidneys, 
liver,  and  digestive  organs  share  in  the  general  process  of 
readjustment  to  the  new  state  of  existence,  all  of  which 
need  to  be  considered  and  which  serve  to  show  the  wis- 
dom of  dela}dng  the  first  bath  for  some  hours.  No 
bath,  however  gently  and  carefully  given,  can  be  man- 
aged without  considerable  handling,  and  there  is  more 
or  less  shock  to  the  nervous  system  in  consequence. 

Preparatory  to  the  hath  the  baby  should  be  smeared  with 
warm  olive  oil,  or  vaselin.  Fresh  lard  can  be  used  if 
none  of  these  are  at  hand.  If  this  is  done  a half  hour  or 
so  before  the  bath  the  cheesy  substance  (vernix  caseosa) 
which  is  on  different  parts  of  the  body  will  be  easily  re- 
moved. Setting  the  bottle  of  olive  oil  in  the  basin  of 
warm  water  for  a short  time  will  make  it  sufficiently 
warm. 

The  room  should  be  well  warmed — temperature  above 
70°  F.  Everything  needed  for  the  bath  should  be  con- 
veniently in  reach  before  the  baby  is  uncovered.  The 
bath  should  proceed  as  rapidly  and  systematically  as 
possible,  the  child  being  covered  on  the  nurse’s  lap  as 
much  as  can  be  arranged.  First  the  head  and  face  are 
washed,  great  care  being  observed  to  avoid  soap  entering 
the  eyes.  The  softest  material  should  be  used  for  washing 
and  drying.  Unless  the  baby  seems  blue  or  chilled  a tub 
bath  is  not  advisable.  The  arms  and  hands,  the  chest, 
abdomen,  the  legs,  and  lastly  the  back,  is  washed,  the 
water  used  being  kept  at  from  100°  to  106°  F.  throughout 
the  bath.  Gentle  patting  rather  than  rubbing  is  pref- 
erable when  drying  the  skin.  Powder  may  be  used  in 


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the  groin  and  under  the  arms.  Eyes  and  mouth  should 
both  be  cleansed  during  the  daily  bath. 

Dressing  the  Cord. — The  physicians  usually  direct  how 
the  cord  is  to  be  dressed.  The  dry  methods,  using  dry 
boracic  acid,  baked  starch,  talcum  powder,  or  zinc  oxide 
powder  and  sterile  gauze,  all  have  their  advocates. 
Others  prefer  an  oily  dressing,  such  as  balsam  of  Peru  and 
castor  oil  or  zinc  ointment.  The  important  thing  is  to 
have  the  dressings  and  material  as  nearly  aseptic  as 
possible — nurse^s  hands  also — during  the  dressing.  The 
stump  of  the  cord  is  turned  upward  on  the  abdomen, 
and  the  dressing  held  in  place  by  the  abdominal  band. 
The  cord  should  in  a few  days  be  dry  and  shrivelled  up, 
and  should  separate  without  leaving  any  erosion  of  the 
surrounding  skin  between  the  fifth  and  fifteenth  day. 
As  a rule,  unless  the  dressing  becomes  wet  or  soiled,  it  is 
best  to  let  it  alone  and  disturb  the  drying  stump  as  little 
as  possible.  If  the  healing  around  the  cord  is  not  perfect 
when  it  finally  separates  an  oily  dressing  may  be  applied. 

Clothing. — The  band  may  be  discarded  when  the  cord 
comes  off,  but  is  usually  worn  from  two  to  three  months. 
In  applying  it  see  that  it  fits  snugly  and  yet  is  not  too 
tight.  It  should  be  sewed  rather  than  pinned,  and 
should  easily  admit  a finger  underneath  it.  A band  too 
tight  interferes  with  both  stomach  and  lung  expansion 
and  causes  much  discomfort.  The  diaper  also  may  cause 
discomfort  by  being  too  tight.  It  should  be  fastened  to 
the  shirt  and  not  the  band.  The  other  articles  of  cloth- 
ing should  be  put  on  with  as  little  turning  and  handling 
as  possible,  the  skirts  being  drawn  up  over  the  feet  rather 
than  down  over  the  head. 

Air. — The  first  immediate  necessity  of  life  for  the  new- 
born infant  is  air,  and  the  nurse  should  insist  on  fresh 
air  being  admitted  at  intervals  to  the  room  in  which  the 
baby  is  kept.  Holt,  one  of  the  leading  authorities,  em- 
phasizes the  necessity  of  fresh  air  for  young  babies,  and 
believes  it  even  more  important  than  when  they  are  older. 
To  secure  this  the  baby^s  mother  and  grandmother  may 


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need  tactful  management,  but  if  care  is  observed  to  pro- 
tect the  baby  from  draughts  objections  can  usually  be 
overcome.  As  a rule,  it  is  better  for  both  mother  and 
child  that  the  child  be  kept  away  from  the  mother  most 
of  the  time. 

Urine  should  be  voided  within  the  first  few  hours,  and 
the  nurse  should  make  careful  observation  regarding  this 
point.  The  first  urine  voided  may  be  so  small  in  amount 
that  it  might  pass  unnoticed.  Very  often  there  is  a red- 
dish deposit  in  the  urine  which  on  the  napkin  resembles 
blood.  This  is  an  evidence  that  the  body  needs  more 
water  to  dilute  the  urine  and  flush  the  kidneys.  If  the 
nurse  is  faithful  in  administering  water  to  the  baby,  it  is 
seldom  that  the  time-honored  remedy,  sweet  spirits  of 
nitre,  will  be  needed  to  stimulate  the  urinary  apparatus. 
Give  the  baby  plenty  of  cool  water  to  drink  from  the  very 
first  day. 

The  bowels  should  move  thoroughly  some  time  during 
the  day.  For  the  first  two  or  three  days  the  movements 
have  a dark  appearance  resembling  tar.  The  term  mecon- 
ium is  given  to  these  first  discharges.  After  the  third 
or  fourth  day  the  character  of  the  discharge  changes. 
The  color  is  lighter,  somewhat  brownish,  occasionally 
greenish.  By  the  end  of  the  first  week  the  movements 
are  yellow  in  color.  This  is  the  normal  color.  The  odor 
resembles  that  of  sour  milk  and  is  not  offensive.  If  the 
stools  remain  brown  in  color  after  about  the  sixth  day  it 
might  be  well  to  see  whether  or  not  the  food  is  deficient. 
If  the  stools  are  foul  smelling,  slimy,  or  frothy  there  is 
some  abnormal  condition  present.  Castor  oil  is  usually 
given  if  any  laxative  is  needed. 

Sleep. — The  normal  infant  should  sleep  most  of  the 
time  during  the  first  few  weeks.  It  should  be  roused  at 
regular  intervals  during  the  day  for  its  food,  and  from  the 
beginning  trained  to  sleep  at  night.  The  question  of 
waking  hours  is  pretty  largely  a matter  of  training  in  the 
first  few  weeks.  A baby  that  is  allowed  to  sleep  all  day 
will  be  more  likely  to  be  active  and  awake  at  night. 


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Nursing. — Until  the  flow  of  milk  is  established  every 
four  hours  is  often  enough  to  allow  the  baby  to  nurse. 
The  first  milk  acts  as  a laxative  and  helps  to  clear  the 
intestines  of  the  meconium  which  has  been  accumulating 
from  the  early  months  of  fetal  existence.  Considerable 
difficulty  is  sometimes  experienced,  by  young  inexperi- 
enced mothers  especially,  in  getting  the  baby  to  nurse, 
and  often  the  attempt  is  abandoned  in  despair,  a most 
unfortunate  abandonment  in  many  cases.  Much  of  the 
difficulty  is  because  the  inexperienced  mother  does  not 
know  how  to  arrange  for  the  business.  She  should  lie 
on  her  side  with  the  shoulders  slightly  elevated.  A 
second  pillow  slipped  under  the  head  helps  in  the  suc- 
cess of  the  operation.  The  arm  should  support  the  baby 
and  the  nipple  be  placed  squarely  in  front  of  its  mouth, 
so  that  it  may  take  hold  easily  and  be  able  to  retain  its 
grasp.  If  the  breast  is  heavy  it  should  be  supported.  If 
the  nipple  is  small  and  flat  it  can  be  drawn  out  with  a 
breast-pump  or  a bottle  from  which  the  air  has  been 
exhausted. 

Trouble  in  nursing  may  come  from  too  full  breasts,  de- 
pressed nipples,  because  the  milk  supply  is  deficient  or 
hard  to  get.  Sometimes  it  flows  more  freely  from  one 
breast  than  the  other;  sometimes  the  baby  seems  too 
weak  to  nurse  satisfactorily.  It  is  never  a good  plan  to 
resort  to  a nursing  bottle  in  such  cases,  for  the  baby  will 
soon  learn  that  he  can  get  the  milk  more  easily  from  the 
bottle  and  refuse  to  try  it  from  the  breast.  A little  milk 
and  water  may  be  dropped  over  the  nipple  while  the  child 
is  nursing  to  induce  it  to  take  hold.  A hot  wet-compress 
over  the  breast  will  help  to  make  the  milk  flow  more 
easily,  or  the  flow  may  be  started  with  the  breast-pump, 
and  when  it  is  flowing  the  baby  may  be  put  to  the 
breast. 

If  the  baby  is  very  tiny,  weak,  or  premature  the  milk 
will  have  to  be  pumped  out  and  fed  to  it.  Patience  will 
usually  overcome  difficulties  in  this  manner.  The  estab- 
lishing of  regular  habits  of  nursing  at  the  very  beginning 


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will  mean  much  in  comfort  for  the  mother  and  health  for 
the  baby.  As  a rule,  for  the  first  few  months  a baby 
should  be  nursed  once  in  two  hours  during  the  day  up  till 
about  10  o’clock  at  night.  Once  between  10  p.  m.  and 
5 A.  M.  is  sufficient,  and  most  babies  can  be  easily  trained 
to  good  habits.  If  the  nipple  is  thrust  in  its  mouth  every 
time  it  cries  digestive  disorders  and  troublesome  days  and 
nights  may  be  expected. 

The  Baby’s  Eyes. — A large  proportion  of  the  cases  of 
blindness  that  exist  among  us  are  due  to  improper  care 
of  the  baby’s  eyes  at  birth  and  within  the  first  few  weeks. 
The  disease  resulting  in  blindness  is  caused  by  a germ. 
It  sometimes  gets  into  the  eyes  during  the  birth  but 
infection  may  be  caused  by  carelessness  on  the  part  of 
nurse,  physician  or  mother  after  the  birth.  The  early 
symptoms  are  redness  and  swelling  of  the  eyelids  and  a 
thin  yellowish  discharge  which  accumulates  in  the  corners 
of  the  eyes.  If  the  disease  is  not  arrested  in  the  first 
twelve  hours  or  so  infiammation  spreads  very  rapidly. 
The  discharge  accumulates  very  rapidly;  the  eyelids  are 
swollen  till  they  are  closed.  If  the  progress  of  the  disease 
is  not  arrested  the  vision  is  soon  destroyed. 

To  keep  the  eyes  free  from  the  discharge  is  an  impor- 
tant part  of  the  treatment.  No  time  should  be  lost  in 
getting  the  doctor  to  prescribe  and  attend  to  the  case. 
The  eye  needs  to  be  irrigated  very  frequently,  in  some 
cases  every  fifteen  minutes.  The  battle  is  won  or  lost  in 
a few  days  and  the  least  neglect  will  easily  result  in 
blindness.  It  requires  some  one  person  to  give  exclusive 
attention  to  the  baby  and  provision  must  be  made  to 
relieve  the  nurse  for  sleep.  The  physician  will  prescribe 
the  fluid  to  be  used  for  cleansing  the  eye  and  how  it  is 
to  be  done.  The  discharge  from  the  eye  is  highly  con- 
tagious and  the  nurse  should  be  careful  not  to  infect  her 
own  eyes  by  rubbing  them  carelessly  with  the  hands. 
Until  the  doctor  comes,  use  a warm  solution  of  boracic 
acid  as  strong  as  it  can  be  made;  with  a bit  of  cotton  let 
the  fluid  enter  at  the  inner  corner  of  the  eye  after  the 


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lids  are  separated  and  continue  till  every  bit  of  discharge 
is  washed  away. 

Points  to  be  Remembered. — Getting  up  too  soon  after 
childbirth  is  a fruitful  cause  of  female  diseases. 

The  young  mother  should  be  very  little  on  her  feet 
for  the  first  six  weeks  after  the  birth,  till  the  parts  have 
returned  to  their  normal  condition. 

Be  sure  to  report  any  sign  of  offensive  odor  about  the 
discharge  to  the  physician. 

If  there  is  a cessation  of  discharge  too  soon  it  also 
should  be  promptly  reported. 

Keep  careful  watch  during  the  first  day  for  signs  of 
hemorrhage  from  the  mother. 

Be  sure  to  cleanse  and  disinfect  your  hands  before 
changing  pads  or  cleansing  the  parts. 

There  is  no  special  reason  for  starving  such  patients, 
but  it  is  well  for  the  first  few  days  for  the  diet  to  be 
either  nourishing  fluids  or  quite  light  foods. 

A patient  may  be  allowed  to  go  from  fourteen  to 
eighteen  hours  without  passing  urine,  but  it  is  quite  pos- 
sible to  allow  them  to  go  too  long. 

Every  home  nurse  should  know  the  methods  that  may 
be  used  to  induce  the  natural  voiding  of  urine. 

If  there  are  fissures  or  cracks  in  the  nipples  there  may 
easily  follow  an  abscess  of  the  breast.  Always  report 
cracked  or  sore  nipples  to  the  doctor. 

If  the  breasts  are  becoming  engorged  decrease  the 
amount  of  fluids  in  the  patient^s  diet. 

One  bowel  movement  each  day  is  a good  rule  to  observe 
in  caring  for  mothers. 

It  is  a serious  mistake  to  allow  a great  many  visitors, 
or  even  a few  if  they  are  apt  to  be  tiresome — until  the 
the  patient  is  out  of  bed. 

In  caring  for  weak  and  delicate  or  premature  babies, 
important  points  to  keep  in  mind  are  to  prevent  heat 
loss,  to  prevent  bad  air,  and  to  prevent  infection. 

Watch  the  stump  of  the  baby’s  cord  for  several  hours 
for  hemorrhage. 


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Do  not  be  in  a great  hurry  to  give  the  baby  his  first 
bath. 

Give  the  baby  plenty  of  fresh  air  and  plenty  of  water 
to  drink. 

If  there  are  signs  of  a reddish  sediment  on  the  baby^s 
napkin  after  urine  has  been  passed  give  him  more  water 
to  drink. 

If  the  baby  is  slow  in  voiding  urine,  try  giving  him  a 
hip  bath  in  a basin  of  warm  water.  It  often  works  like 
a charm. 

Try  to  establish  regular  habits  of  nursing  and  sleeping 
with  the  baby  from  the  beginning. 

REVIEW  QUESTIONS. 

1.  What  do  you  mean  by  involution  and  how  long,  as  a rule, 
does  the  process  take? 

2.  Why  is  it  important  to  report  promptly  any  sign  of  cessation 
of  the  discharge  from  the  mother  and  any  offensive  odor  ? 

3.  Beginning  with  the  birth  what  care  would  you  give  the  mother 
the  first  twenty-four  hours  ? 

4.  Outline  a diet  for  a lying-in  woman  having  a normal  recovery, 
the  menus  to  cover  four  days. 

5.  What  special  effect  is  the  first  milk  expected  to  have  on  the 
baby? 

6.  What  methods  would  you  use  to  induce  a patient  to  void  urine 
when  it  seemed  necessary,  but  she  was  unable  to  accomplish 
it? 

7.  What  are  the  uses  of  an  abdominal  binder  for  such  patients 
and  how  would  you  apply  it? 

8.  Outline  the  care  you  would  give  the  breasts  and  nipples  in  a 
normal  case. 

9.  What  measures  would  you  use  to  prevent  infection  through 
the  nipple  ? 

10.  Mention  some  measures  which  may  be  used  to  give  relief  in 
case  of  after-pains. 

11.  How  long  should  a lying-in  woman  remain  in  bed  after  the 
birth  as  a rule  ? 

12.  Give  some  reasons  why  it  is  desirable  to  postpone  the  baby’s 
bath  for  a few  hours  after  birth. 

13.  What  care  would  you  give  the  baby’s  cord,  give  reasons  for 
what  you  do? 

14.  What  would  you  do  if  the  baby  did  not  urinate  in  due  time? 

15.  IIow  often  should  a new-born  baby  nurse  ? 


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16.  Mention  some  conditions  which  may  cause  trouble  in  nursing. 

17.  Why  is  it  necessary  to  be  especially  careful  of  a new-born 
baby's  eyes  ? 

18.  What  care  should  the  eyes  have  to  prevent  trouble? 

19.  What  are  the  early  symptoms  of  infected  eyes? 

20.  What  general  measures  would  you  use  to  prevent  serious 
trouble  till  the  doctor  arrived — after  a discharge  from  the 
eyes  started  ? 


CHAPTER  XXIV. 


PRACTICAL  NURSING  POINTS  IN  SPECIAL 
DISEASES  AND  CONDITIONS. 

Demonstration  and  Practice  Work, — Arranging  a steam  tent  for 
a child  with  croup.  Proper  methods  of  gargling  and  swabbing 
the  throat.  The  use  of  the  catheter.  Preparation  of  menus  for 
a tuberculosis  patient. 

Sleeplessness  or  Insomnia. — Many  persons  suffer  from 
this  trouble  who  are  not  really  sick.  Good  management 
will  do  much  to  lessen  it.  Avoid  mental  excitement  of 
any  kind  for  three  or  four  hours  before  bedtime.  This 
may  require  the  prohibition  of  reading,  of  concentrated 
thought,  exciting  games  of  discussions,  or  anything  that 
tends  to  stimulate  the  brain.  Tea  or  coffee  should  not 
be  taken  at  the  evening  meal. 

Have  the  sleeping-room  dark  and  quiet,  and  filled  with 
good  air.  Those  w^ho  adopt  tent  life  for  a time  expe- 
rience a disposition  to  sleep  more  than  usual.  The  out- 
door life  is  conducive  to  sleep.  Have  the  body  warm, 
but  avoid  having  the  air  in  the  room  warm.  A tepid 
bath  or  pack  lasting  twenty  minutes  to  a half  hour 
before  bedtime  helps  to  promote  sleep.  Remove  all 
causes  of  physical  discomfort  as  far  as  possible.  See 
that  bed  clothing  is  free  from  wrinkles  and  crumbs. 

A gentle  rub  all  over  the  body  follow^ed  by  rubbing  up 
and  down  the  spine  is  often  helpful. 

Do  not  give  the  patient  a full  meal  at  bedtime,  but  a 
stomach  entirely  empty  is  not  conducive  to  sleep.  A 
cup  of  thin  gruel  or  hot  milk  or  cocoa  sipped  slowly  at 
bedtime  is  a great  help  to  many  persons  wdio  suffer  from 
this  trouble. 

Difficulty  in  passing  urine  can  often  be  relieved  by  one 
or  more  of  the  following  methods: 

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225 


1.  Dry  heat  or  a compress  over  the  bladder. 

2.  Place  the  patient  over  a warm  bed-pan  or  vessel 
partly  full  of  hot  water,  cover  her,  and  leave  the  room. 

3.  Let  her  hear  the  sound  of  running  water. 

4.  Apply  a hot  wet  napkin  over  the  bladder  and 
between  the  thighs. 

5.  Try  gentle  pressure  with  the  hand  over  the  bladder. 

6.  Pour  a stream  of  water  as  hot  as  can  be  borne  over 
the  parts  with  the  patient  on  the  bed-pan. 

7.  Give  a warm  enema.  When  the  bowels  move  the 
patient  may  be  able  to  pass  urine  naturally. 

8.  Raise  the  patient  to  a half  sitting  position  on  the 
bed-pan  unless  there  is  some  reason  why  she  should  not 
sit  up. 

If  all  these  measures  fail  and  the  bladder  should  be 
emptied  without  further  delay,  the  catheter  will  have  to 
be  used  to  empty  it. 

the  catheter  is  an  instrument  of  danger  unless  it  is  kept 
absolutely  clean.  Carelessness  or  lack  of  intelligent 

Fig.  46. — Glass  female  catheter. 

precautions  in  using  the  catheter  is  the  most  frequent  of 
all  reasons  for  inflammation  of  the  bladder  developing. 
As  a general  rule,  the  doctor  will  show  how  it  is  to  be 
done.  Few  home  nurses  will  have  to  use  the  catheter 
until  asked  to  do  so  and  shown  how  by  a doctor  or  fully 
trained  nurse. 

The  catheter  may  be  made  of  rubber,  glass  or  silver. 
In  the  hands  of  those  who  are  not  well  skilled  in  how 
to  use  it  the  rubber  catheter  is  probably  the  safest. 

Before  using  the  catheter  it  should  be  placed  in  a clean 
basin  and  boiled  in  a little  water  for  three  minutes.  It 
is  carried  to  the  bedside  in  the  basin  in  which  it  was 
boiled. 

15 


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The  patient  is  placed  on  her  back  with  the  knees  bent 
and  separated  and  a sheet  is  thrown  over  the  knees  to 
prevent  exposure.  A good  light  is  necessary.  Catherize 
by  sight,  never  by  touch,  or  under  the  cover.  It  is  very 
easy  to  blunder  and  bungle  and  cause  the  patient  suffer- 
ing, even  with  the  best  light  possible.  The  patient 
should  be  on  a bed-pan,  or,  if  not,  a basin  should  be  placed 
to  catch  the  urine. 

Before  touching  the  catheter,  after  it  has  been  boiled, 
the  home  nurse  should  thoroughly  scrub  her  hands,  using 
a brush  and  soap  and  plenty  of  warm  water.  If  no 
other  disinfectant  is  at  hand,  soak  the  hands  in  a warm 
salt  solution.  Have  some  bits  of  clean  cotton  boiled  in 
the  basin  with  the  catheter.  Separate  the  parts  with 
the  left  hand,  wash  them  off  with  the  right,  using  the 
cotton  and  the  boiled  water.  Find  the  opening  from 
the  bladder  and  slowly  insert  the  ^^eye^^  end  of  the 
catheter.  Never  use  force.  When  it  reaches  the  blad- 
der the  urine  will  begin  to  flow.  If  it  ceases  flowing 
before  the  bladder  is  apparently  emptied  move  the 
catheter  slightly,  when  it  will  start  to  flow  again;  with- 
draw slowly.  If  a patient  has  gone  a long  time  with- 
out emptying  the  bladder  and  it  seems  overdistended, 
do  not  empty  it  all  at  once,  but  repeat  the  effort  in  a 
few  hours. 

A douche  is  a stream  of  water,  medicated  or  otherwise, 
directed  against  a part  or  into  a cavity. 

The  vaginal  douche  is  given  for  purposes  of  cleanliness, 
to  check  hemorrhage,  arrest  inflammation,  as  an  astrin- 
gent to  contract  tissue  and  check  secretions,  to  relieve 
pain,  and  as  an  antiseptic  to  promote  healing  of  wounds 
or  abraded  surfaces.  An  important  point  in  the  giving 
of  such  douches  is  the  temperature.  The  hot  vaginal 
douche,  given  to  check  hemorrhage,  should  be  as  hot  as 
can  be  borne — usually  from  1 10°  to  1 15°  F.  When  given 
for  the  relief  of  pain  or  to.  arrest  inflammation,  the  hot 
douche  will  be  more  effectual  than  a tepid  douche.  The 
temperature  should  be  tested  with  a thermometer. 


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227 


When  given  for  cleaning  purposes  a temperature  from 
98°  to  105°  F.  may  be  used. 

Astringent  douches,  in  which  alum,  tannic  acid,  or 
some  astringent  drug  is  used,  are  employed  sometimes  in 
cases  of  leukorrhea  or  relaxed  vaginal  walls. 

Quantity. — The  quantity  of  fluid  is  also  important,  as 
well  as  the  speed  at  which  it  is  given.  In  many  cases  the 
prolonged  effect  of  the  heat  is  the  chief  thing  desired,  and 
the  nurse  can  easily  miss  the  main  object  by  allowing  the 
fluid  to  flow  too  quickly  or  using  too  small  a quantity  to 
be  of  any  use.  In  most  cases  a gallon  douche  is  prefer- 
able to  a smaller  quantity. 

Position. — Douches  are  commonly  resorted  to  by  the 
laity,  and  no  form  of  home  treatment  is  more  abused  or 
less  understood  than  this  one.  In  untrained  or  careless 
hands  a douche  is  quite  capable  of  causing  disease  even 
if  none  existed.  It  is  quite  common  for  women  who  have 
the  douche  habit  to  take  douches  in  a squatting  position, 
sitting  over  a slop-jar.  In  such  cases  the  fluid  is  rarely 
likely  to  remain  long  enough  in  the  vagina  to  do  any 
good,  though  it  may  do  harm.  If  a patient  must  give 
herself  these  treatments  the  best  position  is  either  on  her 
back  in  a bath-tub  or  on  a board  fitted  over  the  tub. 
If  the  hips  can  be  elevated  the  fluid  will  have  a better 
chance  to  do  its  work. 

The  irrigator  should  be  suspended  so  as  to  give  a flow 
of  from  6 inches  to  2 feet,  and  the  tubing  should  be 
rather  small  or  clamped  in  such  a way  as  to  prevent  too 
rapid  escape  of  the  fluid. 

It  is  probably  true  that  the  cleansing  effects  of  the 
vaginal  douche  are  greatly  overestimated  and  the  methods 
used  are  often  careless  in  the  extreme.  A flow  of  water, 
medicated  or  otherwise,  over  other  parts  of  the  body  does 
not  ensure  the  cleanliness  of  the  part.  Some  discharge  is 
usually  carried  away,  but  investigation  after  routine 
treatments  of  this  kind  has  shown  that  a considerable 
amount  of  discharge  still  remains. 

Precautions  and  Dangers. — There  is  much  need  of  cau- 


228 


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tion  regarding  vaginal  douches.  Needless  to  say  that 
surgical  cleanliness  should  characterize  the  fluid,  nozzle, 
and  entire  apparatus  used  in  the  treatment.  Serious 
burns  have  resulted  from  using  fluid  that  was  too  hot. 
A solution  of  bichloride  of  mercury  that  was  too  strong 
has  resulted  in  mercurial  poisoning,  and  in  other  cases  in 
severe  injury  to  the  vaginal  walls.  A solution  of  carbolic 
acid  in  which  the  acid  crystals  were  not  well  dissolved 
has  resulted  in  painful  serious  burns,  and  several  deaths 
have  occurred  from  this  cause. 

In  inserting  the  nozzle  it  should  be  handled  so  as  not 
to  touch  it  with  the  fingers,  and  not  to  allow  it  to  come 
in  contact  with  any  unsterilized  substance  before  intro- 
ducing it  into  the  vagina.  The  labia  is  separated  with 
the  one  hand,  while  with  the  other  the  nozzle  (after  allow- 
ing a little  of  the  fluid  to  escape)  is  directed  downward 
and  backward  for  about  4 inches.  The  douche  should 
be  stopped  before  the  entire  amount  of  fluid  is  ex- 
hausted, and  the  entrance  of  air  into  the  cavity  thus 
guarded  against.  Care  should  be  used  that  the  fluid 
does  not  flow  with  too  much  force.  The  injection  of  air 
into  the  uterus  is  a serious  accident.  In  all  douches 
there  is  always  present  the  danger  of  infecting  the  pa- 
tient. No  nurse  should  advise  such  douches  nor  give 
them  without  a doctor’s  order. 

Typhoid  Fever. — In  typhoid  fever  the  bowels  are  the 
chief  seat  of  the  disease.  Patches  of  the  bowels  become 
ulcerated. 

In  severe  cases  the  ulceration  may  extend  into  the 
important  blood-vessels  causing  serious  hemorrhage, 
and  occasionally  perforation  of  the  bowel  occurs. 

The  management  of  the  feeding  problem  will  have  a 
good  deal  to  do  with  the  successful  outcome  of  the  disease. 

Keep  the  patient  lying  down,  do  not  let  him  sit  up 
or  raise  up  or  get  out  of  bed  for  any  purpose. 

When  milk  is  given,  give  in  small  quantities,  letting 
him  sip  it  slowly. 

Give  plenty  of  cold  water  to  drink.  A glassful  every 


PRACTICAL  NURSING  POINTS 


229 


hour  is  not  too  much.  On  account  of  the  fever,  the  body 
needs  more  fluid  than  usual. 

Never  leave  a delirious  patient  for  a moment  without 
someone  to  watch  him.  Neglect  of  this  precaution 
may  cost  a life. 

Watch  for  bed  sores  and  use  measures  to  prevent. 

Remember  to  avoid  unnecessary  exposure  during  the 
doctor’s  examination  of  the  abdomen. 

Avoid  sudden  turning  over  in  bed. 


Fig.  47. — Typhoid  fever,  showing  necrosis  of  Peyer’s  patches  and  intense 
congestion  of  the  bowel.  {Modified  from  Kast  and  Rumpel.) 


The  cleansing  of  the  patient’s  mouth  is  an  important 
part  of  the  nursing.  It  should  be  done  every  four  hours 
during  the  day  and  twice  during  the  night. 

The  home  nurse  should  always  wash  her  hands  after 
waiting  on  a patient  and  should  invariably  give  them 
a good  scrubbing  before  going  to  meals,  using  a hand 
brush  and  plenty  of  hot  water.  Scald  the  brush  after 
using. 

All  dishes  and  utensils  used  for  such  patients  should 
be  kept  separate  and  boiled  daily.  Bed  and  body  linen 
should  be  disinfected. 

Watch  the  stools  for  signs  of  undigested  milk  and  for 
traces  of  blood. 


HOME  NURSE  S HAND-BOOIC 


230 

Notify  the  doctor  at  once  when  blood  In  the  stools  is 
noticed.  Keep  the  patient  absolutely  quiet  till  he  comes. 

Apply  an  ice  cap  to  the  abdomen.  Exercise  great  care 
to  avoid  bodily  movement  while  the  bed-pan  is  being  used. 
See  that  the  patient  tries  to  avoid  straining  of  the  bowels 
when  using  the  bed-pan. 

Convalescence  after  typhoid  fever  requires  as  careful 
management  as  when  the  disease  was  at  its  height.  Re- 
lapses are  common,  and  occur,  in  the  majority  of  cases. 


Fig.  48. — Examination  of  the  abdomen  in  typhoid  fever. 


as  a result  of  indiscretions  in  diet.  No  solid  food  till  the 
temperature  has  been  normal  ten  days  is  a rule  that  is 
quite  generally  observed.  Semisolid  foods,  such  as  cus- 
tards, milk-toast,  cereals,  etc.,  are  permitted  within  a few 
days  after  the  temperature  drops  to  normal.  Many 
practitioners  allow  solid  foods  earlier  in  convalescence, 
but  the  matter  is  one  in  which  the  nurse  should  exercise 
great  caution.  In  other  respects,  the  management  of 


PRACTICAL  NURSING  POINTS 


231 


the  convalescent  period  after  typhoid  fever  does  not 
differ  much  from  that  in  other  diseases. 

Typhoid  Fever  Diets. 

Dr.  Shattuck^s  Typhoid  Fever  Diet: 

Milk. 

Mellin^s  Food. 

Ice  cream. 

Milk  whey. 

Slip. 

Finely  minced  chicken. 

Eggs,  soft  boiled  or  raw. 

Milk-toast  without  crust. 

Macaroni. 

Blanc  mange. 

Broths. 

Special  Diet: 

Steak;  chop;  white  meat  of  chicken  in  small  amounts. 
Toast;  bread;  cereals. 

Eggs  in  any  form. 

Mashed  potato. 

Tomatoes,  strained. 

Oysters. 

Stewed  fruits. 

Crackers. 

Patients  must  be  told  to  chew  all  food  well. 

Liquids  and  Soft-solid  Diet  {Hewes): 

Weak  stomach.  Weak  heart.  Typhoid: 

First  Day. 

Breakfast:  Indian  meal  mush  with  cream  and  sugar, 
or  with  salt  only  (hot) ; milk,  three  ounces. 

10-11  A.  M.:  Crackers  and  milk,  or  egg-nog. 

Dinner:  Pea  puree  or  potato;  soft  or  cream  toast,  and 
soft-boiled  egg. 

3-4  p.  M. : Custard  or  tapioca. 

Night:  Rice;  milk. 


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HOME  nurse’s  hand-book 


Second  Day. 

Breakfast:  Wheat  germs;  milk. 

10-11  A.  M.:  Crackers  and  milk. 

Noon:  Finely-cut  chicken;  wine  jelly. 

3-4  p.  M. : Chocolate  or  crackers  and  milk. 

Night:  Cream  toast;  apple  sauce. 

Third  Day. 

Breakfast:  Wheat  flakes;  milk. 

10-11  A.  M.:  Crackers  and  milk. 

Dinner:  Two  soft-boiled  eggs;  rice  (custard  or  corn 
starch  at  3-4  p.  m.). 

Night:  Potato  puree;  toast. 

Alternate  diets. 

Pneumonia.  Important  Nursing  Points. — 1.  Conserve 
the  strength  of  the  patient  in  every  possible  way.  Men- 
tal and  physical  effort  are  both  to  be  avoided. 

2.  Attend  carefully  to  ventilation.  In  no  acute  disease 
is  fresh  air  more  important,  but  avoid  draughts..  The 
cold-air  treatment  of  pneumonia,  in  which  the  patient  is 
treated  on  the  roof,  porch,  or  in  a room  with  the  windows 
all  open,  is  advocated  and  practised  by  many  of  the  lead- 
ing medical  men,  and  has  proven  successful  in  cases  that 
at  first  seemed  hopeless.  There  is  no  disease  that  is  not 
made  worse  by  foul  air,  and  this  is  particularly  true  of 
respiratory  diseases. 

3.  Change  the  patient’s  position  often,  but  with  as 
little  exertion  as  possible. 

4.  Encourage  the  patient  to  restrain  ineffectual  cough- 
ing as  far  as  possible. 

5.  Keep  the  patient  quiet,  exclude  unnecessary  visit- 
ors, even  from  the  family.  In  no  disease  is  absolute 
rest  more  essential. 

6.  Be  prepared  for  possible  contingencies  and  secure 
orders  from  the  physician  as  to  what  he  wislies  done. 

7.  In  the  use  of  alcohol  be  especially  careful  to  give 


PRACTICAL  NURSING  POINTS 


233 


the  exact  dose  ordered.  The  laity,  many  of  them  at 
least,  are  firm  believers  in  the  value  of  alcohol  to  tide  over 
critical  points.  They  act  on  the  principle  that  if  a little 
is  good  more  will  be  better.  There  is  a danger  of  over- 
stimulating  the  heart  and  of  giving  more  alchool  than  the 
nervous  system  can  tolerate,  thereby  producing  a con- 
dition of  poisoning  of  the  nervous  organism.  This  is 
more  likely  to  occur  in  patients  who  in  health  are  un- 
accustomed to  any  form  of  alcohol.  This  point  may 
need  a word  of  special  caution  from  the  one  in  charge. 

8.  Sleep  is  especially  important  for  such  patients,  and 
to  combat  sleeplessness  frequently  requires  more  than 
ordinary  judgment. 

9.  Remember  that  there  is  a possibility  of  heart  failure 
even  two  or  three  days  after  the  crisis  in  the  disease. 
Sudden  deaths  have  occurred  in  convalescence  as  the 
result  of  sudden  sitting  up  in  bed.  Throughout  the 
disease  be  constantly  on  the  watch  for  evidences  of  serious 
circulatory  embarrassment. 

10.  Be  alert,  observant,  and  closely  attentive  at  all 
times.  Do  not  leave  such  patients  alone.  Keep  full, 
accurate  records. 

The  diet  in  pneumonia  is  the  ordinary  fever  diet  care- 
fully administered.  Vomiting  must  be  guarded  against 
if  possible,  and  the  food  should  be  such  as  will  not  create 
gas  in  the  stomach  and  still  further  embarrass  breathing. 

Eczema  (otherwise  known  as  tetter  or  salt  rheum)  is 
a noncontagious  inflammation  of  the  skin.  It  occurs  at 
all  ages  and  under  all  conditions  of  life.  About  one-third 
of  all  cases  of  skin  diseases  are  eczematous  in  character. 
It  may  be  acute  or  chronic.  There  are  several  distinct 
varieties  of  the  disease. 

There  is  no  doubt  that  many  individuals  who  suffer 
.repeatedly  from  this  disease  have  a predisposition  to  it, 
and  the  disease  is  provoked  by  very  slight  causes.  In- 
ternal causes  include  disorder  of  the  digestive  organs, 
nervous  affections,  general  debility,  rheumatism,  kidney 
diseases,  and  in  some  cases  uterine  affections. 


234 


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Among  external  causes  are  strong  soaps  containing  too 
much  alkali,  friction  of  the  skin  surfaces,  or  by  clothes, 
dust,  or  any  irritation  to  the  skin. 

Management. — The  best  authorities  are  agreed  that  in  a 
great  many  cases  the  disease  is  due  to  errors  in  dieting. 
The  disease  often  runs  a chronic  course,  may  persist  in- 
definitely, and  recur  again  and  again  unless  the  individual 
will  change  his  habits  of  life  and  especially  of  eating. 
A prominent  physician^  in  charge  of  a skin  clinic  said, 
^^For  every  patient  suffering  from  an  inflammatory  skin 
disease  who  was  eating  too  little  and  suffering  from  lack  of 
nourishment  there  were  a score  or  more  ^vho  were  eating 
too  much,  and  thus  feeding  the  eruption.  The  character 
of  the  food  in  the  treatment  of  cutaneous  and  other 
diseases  is  of  less  importance,  perhaps,  than  the  manner 
in  which  the  food  is  taken.  Hasty  eating,  irregular 
eating,  and  meals  taken  under  the  stress  of  excitement 
and  worry  were  the  daily  experience  of  most  of  our 
patients/^ 

The  skin  is  an  important  secretory  organ,  and  when 
waste  products  accumulate  in  the  blood  faster  than  they 
can  be  gotten  rid  of,  the  glands  that  assist  in  throwing 
off  waste  are  overworked.  The  secretions  of  the  skin 
are  altered.  Irritation  and  finally  eruption  results. 

Diet. — The  regulation  of  the  diet  is  largely  an  indi- 
vidual matter,  but  rich  foods,  and  especially  fried  foods, 
should  be  avoided.  Oatmeal  is  believed  to  intensify 
the  disease,  and  in  individuals  who  are  predisposed  to 
this  affection  should  be  used  sparingly,  if  at  all. 

Foods  prohibited  by  some  leading  medical  authorities 
are  sweet  potatoes,  fried  egg-plant,  cabbage,  cheese, 
bananas,  apples,  soda-water,  syrups,  salt  ham  and  pork, 
and  corned  beef,  fried  oysters,  fatty  foods,  rich  gravies, 
preserves,  and  fancy  desserts  of  all  kinds. 

Foods  allowed  are  whole-meal  bread,  freshly-cooked 
vegetables,  eggs,  milk,  and  fresh  fish  or  meat  not  oftener 
than  once  a day.  Obstinate  cases  have  improved  mark- 

'C.  J.  Fox. 


PEACTiCAL  NUESING  POINTS 


235 


edly  on  a diet  of  bread  and  milk  only,  continued  for  two 
or  three  weeks.  A diet  consisting  of  boiled  rice,  bread, 
butter  and  water  has  produced  marked  results  in  many 
cases.  The  results  of  the  diet  are  usually  apparent  in  four 
or  five  days.  In  most  cases  overeating  and  constipa- 
tion need  to  be  strictly  guarded  against.  Local  treat- 
ment varies  with  the  type  and  stage  of  the  disease.  In 
acute  cases  water  acts  as  an  irritant,  and  is  used  only 
sufficiently  to  secure  ordinary  cleanliness.  Bran,  starch 
or  borax  added  to  the  water  lessens  the  irritant  effect. 
In  chronic  cases  soap  and  water  may  have  a therapeutic 
value.  Linseed  or  olive  oil  are  used  to  soften  the  crusts, 
and  occasionally  starch  or  linseed  poultices  are  applied 
if  the  crusts  are  very  adherent.  In  applying  a starch 
poultice  to  the  head,  thick,  boiled,  laundry  starch  is 
used  and  applied  while  warm  on  a piece  of  cheese-cloth. 
A little  cap  fitted  over  the  head  and  tied  under  the  chin 
is  better  for  keeping  it  in  place  than  a bandage.  It 
needs  to  be  renewed  about  every  two  to  three  hours. 
Very  tenacious  crusts  are  sometimes  loosened  in  a 
night  under  this  treatment.  A great  variety  of  powders, 
lotions,  and  ointments  are  used  in  dealing  with  this 
affection,  but  the  hygienic  and  preventive  treatment  is 
the  one  most  important  to  nurses. 

Itch  is  a contagious  animal  parasitic  disease  char- 
acterized by  intense  itching,  which  is  worse  at  night. 
The  parts  frequently  attacked  are  the  hands  between 
the  fingers,  the  wrist,  axilla,  breasts,  buttocks,  and  the 
inner  side  of  the  legs  and  toes.  The  disease  is  highly 
contagious,  and  may  be  contracted  through  the  medium 
of  towels  and  bed  clothes  or  by  direct  contact. 

The  disease  yields  readily  to  treatment,  but  persists 
indefinitely  if  neglected.  Sulphur  ointment  is  one  of 
the  most  common  and  effectual  of  all  remedies,  or 
suphur  may  be  combined  with  balsam  or  Peru  or  other 
drugs.  A vigorous,  prolonged  hot  soap-and-water 
bath  is  given  before  the  ointment  is  applied. 

Hives. — This  trouble  is  usually  caused  by  some  dis- 


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order  of  the  digestive  tract.  A great  many  people  have 
an  idiosyncrasy  regarding  certain  foods  which  others 
may  take  without  inconvenience.  Foods  liable  to  pro- 
duce hives  are  cheese,  lobsters,  crabs,  sausage,  pork,  nuts, 
strawberries,  oatmeal,  tomatoes,  and  mushrooms.  Many 
drugs  produce  rashes,  and  the  sting  of  the  nettle,  mos- 
quito, or  wasp,  may  also  cause  hives. 

The  treatment  is  directed  toward  clearing  out  the 
stomach  and  intestinal  tract  and  the  allaying  of  the 
itching.  An  emetic,  followed  by  a dose  of  Epsom  salt 
and  an  alkaline  bath,  using  a tablespoonful  of  washing 
soda  to  every  four  gallons  of  water,  are  useful  measures. 
To  relieve  the  itching  equal  parts  of  vinegar  and  water  or 
a carbolic  solution,  1:40,  may  be  applied  locally  to  the 
spots.  Water  in  large  quantities  internally  is  recom- 
mended. In  cases  which  recur  the  diet  should  be  most 
carefully  watched  to  try  to  discover  the  cause. 

Boils. — This  affection  is  a circumscribed  inflammation 
due  to  the  introduction  into  the  skin  of  pus-producing 
germs.  Impoverished  health  may  render  the  soil  favor- 
able, but  it  does  not  produce  the  boils.  One  boil  is 
very  likely  to  infect  the  surrounding  area  and  cause 
numerous  others  unless  careful  disinfection  is  practised. 
Abortive  treatments  usually  fail.  Hot  antiseptic  com- 
presses till  the  softening  takes  place  and  the  slough  or 
core  separates,  careful  disinfection  of  the  surrounding 
area,  and  an  antiseptic  ointment  after  are  the  usual  forms 
of  treatment. 

Chafing  is  a reddening  of  the  skin  where  the  surfaces 
are  in  apposition,  such  as  the  groin,  axilla,  neck,  etc. 
This  is  preventable  in  most  cases  by  cleanliness  and  the 
use  of  an  astringent  dusting-powder  or  vaseline.  A good 
astringment  dusting-powder  is  made  of  equal  parts  of 
zinc  oxide  powder  and  carbonate  of  magnesia.  Boric  acid 
and  zinc-oxide  powder  in  equal  parts  is  also  good.  The 
frequent  application  of  zinc  ointment  where  there  is 
much  moisture  often  gives  better  results  than  the  powder. 

Poison-ivy  Rash. — One  of  the  best  treatments  for  this 


PRACTICAL  NURSING  POINTS 


237 


IS  the  application  to  the  inflamed  parts  of  black  wash  and 
before  the  part  is  quite  dry  smearing  with  oxide  of  zinc 
ointment.  Carbolized  olive  oil  applied  locally  often 
gives  good  results  in  these  cases. 

When  erysipelas  is  suspected  send  for  the  doctor  at 
once.  Till  he  comes,  apply  to  the  inflamed  part  a com- 
press wet  with  a strong  solution  of  Epsom  salts  and  water 
as  much  of  the  salts  being  used  as  the  water  will  dissolve. 
Keep  the  dressing  quite  moist  with  this  solution  and  give 
only  fluid  diet. 

Appendicitis. — If  this  disease  is  feared  put  the  patient 
to  bed  and  do  not  let  him  get  up  for  any  purpose.  Send 
for  the  doctor  at  once.  In  such  cases  the  doctor  is  never 
called  too  early,  he  is  often  called  too  late.  Apply  an 
ice  cap  to  the  abdomen.  Give  no  solid  food.  Milk, 
broths,  ice  cream,  and  fruit  juices  may  be  given.  Give 
no  medicine  without  a doctors  order. 

Surgery  is  usually  resorted  to  sooner  or  later. 

Appendicitis  tends  to  return  in  many  cases.  In  the 
recurrent  cases  the  diet  should  be  carefully  regulated. 

The  patient  should  be  cautioned  to  eat  moderately  and 
avoid  all  coarse  or  hard  foods  such  as  grits,  coarse  oat- 
meal, tough  meats,  fibrous  vegetables,  the  skin  of  fruits 
or  potatoes,  in  short  everything  likely  to  overload  the 
intestine  with  accumulated  waste.  Recurrent  attacks 
of  appendicitis  are  more  apt  to  be  excited  directly  by 
overeating  and  improper  food.  — Thompson. 

Diphtheria. — Remember  that  rest  in  bed  is  of  the 
utmost  importance  till  all  danger  is  past. 

Heart  failure  is  to  be  feared  at  any  time  during  the 
course  of  the  disease  and  often  occurs  during  convales- 
cence. Sudden  exertion  is  to  be  avoided. 

If  there  is  difficulty  in  breathing,  moist  air  will  usually 
help  to  relieve  it. 

Paralysis  in  some  form  is  not  uncommon,  but  recovery 
is  the  rule.  See  that  the  patient  has  plenty  of  pure  air 
to  breathe  day  and  night. 

Whooping  cough  runs  a certain  course  and  there  seems 


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to  be  no  way  of  cutting  it  short.  The  sickness  may  be 
lengthened  by  bad  management. 

Avoid  sudden  changes  of  temperature  and  chilling. 

Keep  the  patient’s  strength  up  by  careful  and  v/ise 
feeding.  Nourishment  is  of  special  importance. 

The  purity  of  the  air  in  the  room  has  a good  deal  to 
do  with  the  frequency  and  severity  of  the  spasms. 
Bronchitis  and  pneumonia  are  always  to  be  feared  as 
complications. 

Hot  baths  toward  evening  are  strongly  recommended 
by  some  prominent  physicians.  The  child  should  stay 
in  the  bath  about  fifteen  minutes,  a cold  cloth  being  kept 
on  the  head. 

Put  on  fresh  clothing  twice  a day.  Reinfection  often 
occurs.  Careful  attention  to  the  purity  of  the  air  in  the 
room,  to  clean  clothing,  and  the  warm  baths  at  night, 
will  help  to  lessen  the  attacks  of  coughing,  and  allow 
the  little  patient  to  gather  strength  through  sleep  at 
night. 

Bronchitis. — Mustard  foot  baths  are  often  helpful  in 
the  early  stages.  Inhalations  of  steam  tend  to  loosen 
the  secretion  and  relieve  difficult  breathing.  Flaxseed 
tea  is  a useful  drink  in  cases  of  this  kind.  A mild  mus- 
tard plaster  to  the  chest  is  often  recommended.  Sudden 
changes  of  temperature  should  be  avoided.  The  air  in 
the  room  should  be  moist.  Mild  laxative  medicine  of 
some  kind  is  usually  needed.  The  diet  while  there  is 
fever  should  be  liquid  or  very  light. 

Measles. — Keep  the  patient  in  bed  in  a well  ventilated 
room.  Exclude  the  light  wholly  or  partly  owing  to  the 
inflamed  condition  of  the  eyes. 

While  the  fever  lasts  give  liquid  diet. 

A warm  bath  every  day  may  be  given. 

The  complications  to  be  feared  are  bronchitis  and 
pneumonia.  Whooping  cough  frequently  follows  measles 
and  many  cases  of  tuberculosis  have  been  traced  back 
to  this  disease  which  weakens  the  body  and  leaves  it 
m good  condition  for  the  development  of  other  diseases. 


PRACTICAL  NURSING  POINTS 


239 


German  measles  is  a different  and  distinct  disease 
though  the  management  of  the  two  is  the  same. 

Summer  diarrhea  is  one  of  the  exceedingly  fatal  diseases 
among  infants.  It  is  especially  prevalent  in  densely 
populated  communities.  Occasionally  the  disease  per- 
sists for  several  weeks,  and  complications  are  numerous. 
As  a rule,  it  is  rapidly  fatal  unless  checked.  The  imme- 
diate cause  is  due  to  posion  developed  in  the  food  by 
the  action  of  germs  as  a result  of  high  temperature, 
and  the  disease  is  readily  communicated  by  means  of 
soiled  hands  or  utensils.  See  page  147. 

Preventive  treatment  consists  in  keeping  the  babies  clean 
and  as  cool  as  possible  in  hot  weather,  and  in  most  careful 
attention  to  the  cleanliness  of  food  and  utensils.  Hy- 
gienic management  is  the  first  step  in  the  prevention. 

General  Management, — When  the  disease  manifests  it- 
self the  first  essential  is  to  clear  the  offending  contents 
of  the  stomach  and  intestines  out  as  rapidly  as  possible. 
Diarrhea  and  vomiting  are  efforts  in  this  direction,  but 
prompt  assistance  is  needed. 

Irrigation  of  the  bowels  is  one  of  the  most  effective 
of  all  treatments.  The  child  should  be  placed  on  the 
back,  hips  elevated,  and  a large  soft-rubber  catheter 
used.  In  a baby  of  six  months  a pint  of  salt  solution 
will  usually  be  sufficient  and  a quart  for  a child  of  two 
years.  The  tube  should  be  well  oiled  and  passed  up 
from  6 to  8 inches.  If  there  is  high  fever  ice-water 
is  sometimes  used  for  irrigation,  but  normal  salt  solution, 
luke  warm,  is  the  most  common  fluid.  The  stools  should 
be  closely  watched  and  changes  in  character  reported. 

Borax  solutions,  using  a dram  of  borax  to  a pint  of 
water,  is  occasionally  resorted  to.  Ask  the  doctor  before 
giving  it. 

Diet. — Milk  is  very  generally  withheld  for  a few  days. 
Albumin-water,  with  or  without  the  addition  of  a little 
brandy;  barley-water,  arrowroot  gruel,  milk  whey,  or 
koumiss,  and  beef  juices  and  broths  are  all  recommended. 
Osier  says  that  in  these  cases  there  is  no  form  of  nourish- 


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merit  so  readily  assimilated  and  apt  to  cause  so  little  dis- 
turbance as  egg  albumin  or  the  simple  beef  juices.  When 
a return  to  milk  diet  is  made  the  milk  should  be  sterilized. 

Frequent  baths,  either  tub  or  sponge,  help  to  keep  the 
child  cool,  which  is  an  important  aid  in  tiding  over  the 
disease.  A change  to  the  cooler  air  of  the  seashore  or 
even  to  the  parks  in  the  daytime  is  often  helpful. 

Starch  and  laudanum  injections  are  useful  aids  in  this 
disease. 

Water  given  freely,  even  when  immediately  vomited, 
is  recommended  by  some  medical  writers. 

Croup  (Spasmodic). — Apply  hot  compress  to  the  neck. 
Keep  the  air  in  the  room  moist.  Encourage  vomiting 
if  the  attack  is  very  severe.  Ask  the  doctor  about 
emergency  medicines  if  the  child  is  subject  to  frequent 
attacks.  Syrup  of  ipecac  is  often  recommended  for  the 
purpose  of  assisting  vomiting,  the  dose  being  graded  ac- 
cording to  the  age  of  the  child. 

A steam  tent  is  often  needed  in  cases  of  croup  or  bron- 
chitis. To  arrange  this,  drape  a sheet  over  the  crib, 
supporting  it  at  the  head  of  the  bed  by  fastening  it  to 
the  wall  or  to  a pole  resting  against  the  wall  at  the 
head,  and  on  the  mattress  at  the  foot  of  the  crib.  The 
steam  may  be  conducted  from  *a  small  kettle  at  the  side 
of  the  bed,  heated  by  a gas  or  coal-oil  stove.  A tube 
of  thick  paper  fitting  over  the  spout  of  the  kettle  con- 
ducts the  steam  under  the  tent. 

Inhalation  for  larger  children,  or  in  adults  to  relieve 
difficulty  in  breathing  or  influenza  and  bronchitis,  may 
be  arranged  by  wrapping  a shawl  or  small  blanket 
around  the  head  and  shoulders,  the  head  being  held  over 
a pitcher  filled  with  boiling  water.  A few  drops  of  car- 
bolic acid  or  Friar’s  balsam  may  be  dropped  in  the  water. 
The  shawl  should  envelop  the  pitcher  and  keep  the  steam 
from  escaping  into  the  room. 

Colds. — Wlien  a cold  is  developing  one  of  the  first 
things  to  l)e  done  is  to  give  castor  oil,  salts,  or  a cathartic 
of  some  kind.  If  there  is  fever  give  fluid  or  light  diet, 


PEACTICAL  NURSING  POINTS 


241 


2 

Fig.  49. — Croup-tent  for  steaming  and  calomel-fumigation:  1.  Croup-tent 
open.  The  fumigation  apparatus,  standing  on  the  table,  consists  of  a Bunsen 
burner,  a tripod,  and  a plate  containing  calomel.  2.  Calomel-fumigation: 
croup-tent  closed,  nurse  watching  the  child  while  fumigation  is  going  on. 
{Northrup.) 

16 


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and  keep  the  patient  in  bed.  Give  plenty  of  fresh  air  to 
breathe  day  and  night  and  wait.  Relief  where  breathing 
is  difficult  may  be  obtained  by  steam  inhalations.  Warm 
olive  oil  dropped  into  the  nose  helps  to  clear  the  passages. 
Colds  tend  to  run  a definite  short  course.  One  day 
cold  cures  are  apt  to  be  disappointing. 

Gargles. — When  it  is  necessary  to  gargle  the  throat, 
instruct  the  patient  to  fill  the  mouth  with  the  fluid,  close 
the  nose  tightly,  throw  the  head  backward,  and  gargle. 
Unless  used  properly,  gargles  are  of  little  value. 

Convulsions  in  children  are  often  caused  by  indigestion. 
Send  for  the  doctor  as  soon  as  possible.  Empty  the 
lower  bowel  by  an  enema.  Get  the  child  to  vomit. 

If  the  stomach  seems  to  be  overloaded,  use  a little 
mustard  and  luke-warm  water  as  an  emetic  if  necessary. 
Give  a hot  mustard  bath  as  soon  as  possible,  leaving  the 
child  in  it  till  the  skin  is  well  reddened.  About  two 
tablespoonfuls  of  mustard  may  be  used  to  a child^s 
bath  tub  of  water,  blending  the  mustard  to  a smooth 
paste  in  cold  water  before  stirring  it  in. 

Constipation  in  Babies. — Griffith  suggests  as  possible 
remedies  an  increase  of  fat  in  the  food  or  more  cream  to 
the  bottle  or  fed  from  a spoon. 

A teaspoonful  of  olive  oil  daily. 

A teaspoonful  of  ^^drug  store  syrup  two  or  three 
times  a day. 

Oatmeal  water  instead  of  plain  water  in  preparing 
food. 

Orange  juice. 

A baked  apple  or  stewed  fruit  may  be  tried  in  children 
over  one  year  of  age. 

Strained  prune  juice. 

Cultivation  of  regular  habits  in  evacuating  the  bowels. 

Increase  of  fluids  and  laxative  foods. 

Massage. 

Occasional  enemata. 

Lastly,  laxative  drugs,  of  which  cascara  or  syrup  of 
senna  are  two  of  the  best. 


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243 


Plenty  of  fresh  air  and  outside  exercise  are  important 
factors  in  management.  It  is  well  for  nurses  to  remem- 
ber that  the  tendency  of  lime-water  in  food  is  toward 
constipation. 

Habitual  constipation  in  adults  is  rarely  if  ever  cured 
by  drugs.  In  fact  in  many  cases  drugs  seem  to  increase 
the  trouble.  Careful  attention  to  diet  and  to  habits 
of  living  is  necessary. 

The  normal  condition  regarding  bowel  movement 
is  that  each  individual  should  have  at  least  one  evacuation 
of  the  bowels  each  day.  There  are  various  deviations 
from  this  rule  in  the  way  of  increased  movement,  which 
up  to  a certain  point  do  not  affect  the  general  health,  but 
if  at  least  one  bowel  movement  does  not  take  place  each 
day  the  health  is  sure,  sooner  or  later,  to  suffer  from 
retention  of  waste  products  in  the  system. 

Habit  is  a strong  controlling  factor  in  this  matter,  and 
an  effort  to  empty  the  bowel  at  a regular  time  each  day 
should  be  made  until  the  habit  is  established. 

Water, — Copious  drinking  of  pure  water  tends  to  pro- 
mote the  normal  action  of  the  bowels,  but  too  much  water 
should  not  be  used  at  meals.  For  laxative  purposes,  a 
glass  of  either  hot  or  cold  water,  with  or  without  the  addi- 
tion of  a pinch  of  salt,  taken  on  rising  in  the  morning, 
proves  a sufficient  remedy  in  a great  many  cases. 

Food. — The  character  of  the  food  also  has  a decided 
action  on  peristalsis.  A great  many  vegetables  have  a 
tough  woody  fiber  which,  though  indigestible,  performs  a 
useful  function  in  contributing  to  the  bulk  of  food  needed, 
and  thus  stimulate  peristalsis.  Of  these,  green  corn 
and  turnips  are  examples.  Coarse  cereal  foods,  such  as 
hominy,  oatmeal,  and  crushed  wheat,  brown  bread,  and 
bran  biscuits,  all  have  a slight  laxative  effect.  The 
addition  of  cream  to  an  infantas  food  will  often  correct  any 
tendency  to  constipation.  Olive  oil  is  a laxative  fat 
and  its  use  has  been  followed  by  very  beneficial  results  in 
many  cases.  Those  who  dislike  it  as  an  addition  to 
salads,  etc.,  may  take  it  clear  two  or  three  times  a day. 


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Fruits  act  as  laxatives  through  their  seeds  and  through 
the  action  of  the  acids  and  salts  they  contain.  For  lax- 
ative purposes'  fruits  should  be  eaten  between  meals  and 
on  rising  in  the  morning.  The  laxative  action  is  in- 
creased if  the  fruit  is  followed  with  a glass  or  two  of 
water.  Preserved  fruits  are  not  so  effectual  as  fresh,  and 
bananas  are  said  to  cause  constipation.  The  following 
list  of  fruits  have  a laxative  effect:  Prunes,  oranges, 
grapefruit,  apples,  cooked  or  raw,  peaches,  berries. 

Butter-milk,  apple  cider,  koumiss,  honey,  rhubarb,  wal- 
nuts, almonds,  and  fresh  green  vegetables  are  all  useful 
articles  of  diet  when'  there  is  a tendency  to  constipation. 

Exercise. — Active  exercise  of  the  body  tends  to  pro- 
mote the  normal  action  of  the  intestines.  Those  who 
lead  a sedentary  life  or  are  confined  to  bed  require  that 
special  care  in  diet  be  used  if  constipation  is  to  be  avoided. 

Massage  of  the  abdomen  is  used  with  especial  benefit 
in  children,  where  natural  simple  measures  are  not  suffi- 
cient to  produce  a normal  action  of  the  bowels.  Begin 
at  the  right  groin  and  follow  the  course  of  the  colon 
around  the  abdomen. 

Abortion  or  Miscarriage. — The  terms  abortion’^  and 
miscarriage^^  are  used  interchangeably  by  most  people 
though  in  medical  circles  there  is  a distinction  made  in 
the  use  of  the  terms.  The  condition  is  due  to  a variety 
of  causes.  The  immediate  danger  in  either  case  is  from 
hemorrhage.  A more  remote  but  no  less  real  danger  is 
from  infection  which  results  in  a form  of  blood  poisoning. 

The  important  symptoms  are  a slight  flow  of  blood 
from  the  vagina,  and  a sense  of  pain  or  uneasiness  in  the 
abdomen  after  pregnancy  has  begun.  Abortion  occurs 
most  frequently  in  the  third  month  of  pregnancy.  In 
cases  where  repeated  al^ortions  occur,  treatment  should 
l)cgin  as  soon  as  pregnancy  begins  or  before.  In  many 
cases  the  symptoms  subside  under  appropriate  man- 
agement and  the  j)regnancy  continues  without  further 
interruption.  Iwcn  large  hemorrliages  are  not  always 
followed  by  abortion  or  miscarriage. 


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245 


When  a miscarriage  is  threatened  ^^it  is  a good  plan  to 
keep  the  patient  on  her  back,  with  the  foot  of  the  bed 
elevated  from  10  to  12  inches,  and  only  a small  pillow 
under  her  head.  This  posture  reduces  the  flow  of  blood 
into  the  abdominal  organs,  and  has  a marked  tendency 
to  empty  the  veins.  The  importance  of  absolute  mental 
quietude  cannot  be  overestimated,  nor  too  much  im- 
pressed upon  the  patients  friends/^ 


Fig.  50. — Bed  elevated  at  foot,  showing  chair  protected  to  prevent  scratching. 

Opium  in  some  form  is  usually  given  as  an  emergency 
remedy  in  small  doses  and  often  repeated;  asafetida  is 
given  in  many  cases  where  treatment  needs  to  be  con- 
tinued for  a considerable  time. 

Hemorrhage — In  all  such  cases  a physician  should  be 
secured  at,  the  earliest  possible  moment.  If  the  bleed- 
ing [is  profuse,  Davis  recommends  a vaginal  injection 
of  hot  sterile  water.  This  might  be  done  while 
waiting  for  the  doctor  if  his  coming  was  delayed. 
Other  stimulants  or  hot  drinks  should  not  be  used 
without  special  orders.  Ice  may  be  applied  over  the 
uterus.  The  patient  should  not  be  allowed  to  get  out 


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of  bed  or  raise  up  in  bed  for  any  purpose.  All  napkins 
or  discharges  should  be  saved  for  the  physician's 
inspection. 

Convalescence  after  abortion  is  a much  slower  process 
than  after  a full-term  birth.  The  latter  is  a natural  pro- 
cess, the  former  a diseased  condition.  Chronic  diseases 
or  conditions  often  result.  In  all  cases  there  is  the  dan- 
ger of  infection  from  retained  placental  tissues  or  mem- 
branes. It  is  said  that  ^^most  women  at  the  time  of  an 
abortion  or  miscarriage  are  prone  in  an  exceptional  degree 
to  infection."  Hemorrhage  after  curettement  in  such 
cases  frequently  occurs. 

Tuberculosis.  Advice  to  Patients  having  Tuberculosis.^ 
— Anyone  suffering  with  consumption  in  its  early  stages 
should  remember  that  this  condition  is  a very  common 
one,  and  one  from  which  large  numbers  of  people  have 
fully  recovered.  It  is  only  necessary  to  firmly  implant 
in  the  patient's  mind  that  his  condition  is  very  serious 
unless  he  follows  out  with  the  greatest  care  the  necessary 
rules  of  living;  with  this  latter  provision  he  may  look  for- 
ward with  confidence  to  a cure. 

The  condition  is  one  which  should  cause  no  fear  if 
the  most  simple  laws  of  animal  health  are  observed. 
The  benefit  derived,  or  the  completeness  of  the  cure, 
depends  almost  entirely  upon  the  earnest  and  sincere 
efforts  of  the  patient.  The  doctor,  except  in  an  emer- 
gency, can  act  only  as  an  advisor. 

The  cardinal  features  of  the  cure  of  this  disease  are: 

1.  Rest. 

2.  Good  food. 

3.  Fresh  air. 

4.  An  easy  and  composed  mental  condition. 

In  addition,  one  must  be  willing  to  sacrifice  temporary 
pleasures,  to  live  a most  monotonous  life,  to  have  an 
intense  desire  to  get  well  and  an  honest  belief  in  ultimate 
recovery. 

Sufficient  resources  are  required  for  all  necessities, 

‘ Bulletin  Ohio  State  Sanatorium,  Mt.  Vernon,  Ohio. 


PRACTICAL  NURSING  POINTS 


247 


such  as  re-arrangement  of  sleeping  quarters,  proper  and 
sufficient  food  and  correct  wearing  apparel. 

The  hygiene  of  self  and  surroundings  is  of  the  great- 
est importance.  It  must  be  understood  that  a great 
battle  is  to  be  fought,  lasting  at  least  a year;  therefore, 
as  in  all  such  cases  ammunition  must  be  available. 

We  shall  take  up  first,  the  question  of  Rest.  This 
means  rest  in  the  truest  sense  of  the  word — not  simply 
to  stop  work,  but  rest  in  bed,  chair  or  hammock,  all 
depending  on  the  condition  of  the  patient.  When  there 
is  fever  or  exhaustion,  bed  is  the  proper  place,  and  even 
though  one  feels  almost  well,  the  hours  of  quiet  must 
be  five  to  one  of  exercise  or  excitement.  The  manner  of 
rest,  the  place,  surroundings  and  number  of  hours 
should  be  arranged  by  the  physician. 

Good  food  and  plenty  of  it  is  essential,  the  amount 
and  variety  depending  upon  the  patient  and  his  ability 
to  utilize  what  is  given.  The  great  desire  in  feeding  is 
to  have  a gain  in  weight,  every  ounce  of  increase  mean- 
ing an  advance  toward  health.  In  most  cases,  it  is 
best  to  take  food  regularly  and,  of  course,  faithfully 
remembering  that  water  must  be  classed  as  a food. 
A definite  schedule  should  be  made  for  the  day. 

For  instance,  at  6.30  a glass  of  hot  water  while  still  in 
bed;  at  7.15  or  8 a.  m.  breakfast,  to  consist  of  fruit, 
cereals,  toast,  eggs,  and  perhaps  a little  meat,  with 
milk  or  water;  the  largest  meal  of  day  must  be  at  12.30 
or  1 p.  M.,  consisting  of  almost  anything,  within  reason, 
that  the  patient  may  desire.  (A  rest  on  the  couch  of  an 
hour  should  then  be  taken.) 

The  evening  meal  at  6 p.  m.  must  be  of  light  easily 
digestible  food  and  eggs  with  milk. 

At  9.30  preparation  for  bed  should  begin  and  all  be 
asleep  by  10  o^clock. 

In  some  cases  special  diet  in  addition  may  be  necessary, 
viz.:  egg-nogg  with  crackers  at  10.30  a.  m.  and  3-3.30 
p.  M.;  also  a glass  of  hot  milk  with  crackers  at  bedtime. 
This,  however,  is  to  be  determined  by  the  physician. 


248  HOME  NURSE^S  HAND-BOOK 

Fresh  air  is  of  almost  as  much  importance  as  good 
food,  for  while  food  is  necessary  to  the  entire  body, 
fresh  air  is  equally  essential  to  the  diseased  and  starved 
lung  cell.  Few  people  appreciate  what  is  meant  by 
fresh  air;  it  means  the  open — the  sky  above  and  earth 
below.  Of  course,  we  are  compelled  to  have  some  pro- 
tection from  the  weather,  hence  several  different  modes 
of  living  are  suggested.  First,  and  best,  is  a tent  or 
modified  tent  house  put  up  in  the  yard;  next,  a remod- 
eled porch  (first  or  second  story),  as  a sleeping-room,  or, 
for  a moderate  sum,  a porch  can  be  built  out  from 
window  or  door;  third,  is  a bed-room  arranged  for  sleeping 
only,,  with  a window  tent  under  which  to  place  the  bed; 
as  a last  resort,  the  bed-room  with  open  windows  and 
properly  arranged  furniture,  may  be  used  to  good  ad- 
vantage. The  physician  can  easily  give  information 
about  all  the  necessary  things  and  their  arrangement, 
to  suit  the  condition  of  the  patient. 

One  of  the  most  important  aids  in  the  cure  of  the 
patient — one  without  which  we  are  practically  helpless 
— is  a proper  condition  of  mind.  Very  many  patients 
put  all  dependence  in  the  doctor  and  nurse,  making  not 
the  least  effort  to  help  themselves.  This  indifference, 
or  perhaps  depression,  on  the  part  of  the  patient,  is 
one  cause  of  the  frequent  failures.  To  succeed  in  any 
battle,  one  must  have  knowledge  and  pluck  a great 
determination  to  win  and  to  not  be  discouraged  by  few 
or  many  backsets.  The  time  will  surely  come  when 
one  is  tired  of  resting,  tired  of  fresh  air,  tired  of  eating 
eggs  and  milk,  tired  of  everything,  in  fact  almost  ready 
to  cry  quits. At  this  time  the  patient  must  appeal 
again  to  his  courage  and  determination  to  win,  or  the 
doctor,  nurse,  fresh  air  and  good  food  are  of  but  little 
use.  The  great  hope,  the  chance  of  success,  is  in  the 
patient^s  desire  and  determination  to  win,  no  matter  what 
the  odds  may  l)e.  A strong  effort  and  the  burden  will  be 
lifted,  with  a further  advance  along  the  road  to  recovery. 

Another  thing  to  consider  is  the  proper  wearing 


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249 


apparel.  So  many  times  the  patient  comes  to  the  doctor 
wearing  one  or  more  heavy  fleece  lined  undervests,  and 
often  a thick  flannel  chest  protector  (so-called),  thick 
clothes  and  overcoat  in  winter,  with  a long  muffler  wrapped 
several  times  around  the  neck,  while  frequently  the  feet 
will  be  poorly  protected — perhaps  wet.  Even  in  the 
house  and  in  bed  the  weight  of  so  much  heavy  clothing 
tires  the  patient. 

The  patient  must,  of  course,  be  warm  and  comfortable 
out  of  doors,  in  the  house  and  in  bed.  Usually  the  phy- 
sician can  advise  as  to  the  needs.  The  following  dress, 
under  ordinary  circumstances,  will  be  found  comfortable 
in  winter,  spring  and  fall;  a thin  summer  under  suit, 
next  to  the  skin,  over  this  a medium  weight  cotton  or 
wool  garment.  The  thin  material  absorbs  perspiration 
and  the  body  heat  quickly  dries  it,  so  there  is  constantly 
a warm  volume  of  air  between  the  two  suits,  the  heavy 
outer  one  retaining  the  warmth;  whereas,  when  one  thick 
garment  is  worn  and  becomes  wet  with  perspiration,  it 
rarely  dries,  hence  causing  a cold,  clammy  sensation, 
and  then  the  loading  on  of  more  clothes  in  a vain  en- 
deavor to  get  warm.  The  outer  apparel  may  be  of  any 
light,  warm  material,  depending  upon  the  means  of  the 
patient;  a warm  overcoat,  when  necessary,  and  good 
strong  shoes.  While  sitting  out  of  doors  in  cold  weather, 
foot-warmers,  extra  blankets  and  a good  warm  cap 
with  ear  coverings,  may  be  needed. 

The  bed  clothes  should  be  light  and  warm;  some  people 
prefer  sleeping  between  blankets  which  is  allowable  if 
changed  sufficiently  often. 

Personal  hygiene  is,  of  course,  important.  A daily 
bath  in  luke-warm  or  cold  water,  followed  by  a brisk 
rub,  is  very  helpful,  keeping  the  skin  in  good  condition 
and  aiding  elimination.  Even  though  confined  to  bed,  a 
sponge  bath  should  be  given  with  a weak  alcohol  rub 
and  thorough  drying  afterward. 

The  greatest  care  must  be  taken  of  any  expectoration. 
Some  prefer  cotton  or  gauze  handkerchiefs,  others 


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special  vessels  made  for  the  purpose,  all  to  be  burned 
after  using. 

The  room  furnishings  should  be  arranged  under  the 
physician’s  direction;  absolute  simplicity  with  subse- 
quent cleanliness  being  the  important  feature. 

One  more  item  in  this  abbreviated  routine  for  living 
must  be  mentioned;  in  plain  words — money.  The 
amount  will  not  be  very  much  if  wisely  used.  An  ordi- 
nary tent  10X12  costing  about  $25.00  with  a built 
up  floor  may  be  used;  better,  a shack  with  tar  paper  or 
shingle  roof  and  canvas  or  wooden  sides,  to  be  raised  or 
lowered,  as  the  weather  demands.  The  remodeling  of  a 
porch  is  many  times  easier  to  arrange,  simple  canvas 
curtains  being  all  that  is  necessary  if  properly  placed. 
If  a room  in  a house  must  be  used,  a very  satisfactory 
window  tent  can  be  obtained  for  about  $10.00.  Gauze 
for  use  as  handkerchiefs  is  very  cheap  and  individual 
expectoration  cups  are  comparatively  inexpensive. 
Blankets  and  head  coverings  can  be  had  in  almost  every 
home,  as  well  as  hot  bricks  or  hot  irons  for  foot  warmers. 

The  milk,  eggs  and  general  diet  will,  in  the  long  run, 
amount  to  no  more  than  the  regular  food  of  a healthy 
person  so  the  cost  need  not  be  considered  excessive. 

In  conclusion,  it  must  be  again  emphasized  that  the 
greatest  chance  of  success  is  in  the  patient’s  sincere  and 
honest  effort  to  follow,  faithfully,  the  advice  and  instruc- 
tions of  the  physician,  then,  all  other  things  being  equal, 
a favorable  outcome  may,  in  most  cases,  be  predicted. 

If  the  patient,  even  for  one  day,  fails  to  observe  the 
rules  herein  given,  he  lessens,  if  he  does  not  destroy,  his 
chances  to  win. 

NURSING  IN  OTHER  PEOPLE’S  HOMES. 

The  woman  or  girl  who  knows  even  a little  about 
proper  care  of  the  sick  is  fairly  certain  whether  she 
desires  or  not  to  be  called  to  assist  in  nursing  in  other 
j)eople’s  homes.  In  entering  another  home  in  time  of 
illness,  the  home  nurse  gets  possession  of  family  secrets. 


PRACTICAL  NURSING  POINTS 


251 


t 


The  most  frequent  complaint  made  about  ^^practicar^ 
nurses  is  that  they  do  harm  with  their  tongues.  They 
may  be  willing  and  helpful  .and  the  doctor  would  gladly 
recommend  them  and  employ  them  on  other  cases  were 
it  not  that  they  have  an  uncontrollable  desire  for  gossip- 
ing about  people. 

The  most  important  things  to  remember  in  starting  to 
nurse  in  other  people^s  homes  are  that  the  nurse  must  not 
allow  herself  to  discuss  the  doctor,  to  criticise  or  com- 
plain about  his  habits,  manner  or  methods.  She  must 
not  carry  tales  about  one  home  or  family  to  another 
person  or  home. 

These  two  habits,  if  the  nurse  is  known  to  have  them, 
will  lead  both  doctors  and  patients  to  refuse  to  employ 
her.  Therefore  if  she  wants  to  succeed  she  must  learn 
to  control  her  tongue. 4^ 

Do  not  discuss  your  own  affairs  and  especially  your 
ailments  in  a patient’s  home.  This  is  another  common 
failing. 

Give  the  patient  and  relatives  a chance  to  be  alone 
occasionally.  Always  leave  the  room  during  the  doc- 
tor’s visit  to  give  him  and  the  patient  an  opportunity 
for  private  conversation.  It  is  better  to  make  a practice 
of  doing  this  than  to  wait  to  be  asked  to  do  it,  as  some- 
times happens. 

Pleasing  the  patient  is  an  important  part  of  nursing. 
Make  as  few  demands  as  possible  and  ask  nobody  to  do 
for  you  what  you  can  do  yourself.  Learn  from  the 
beginning  to  wait  on  yourself  if  you  would  be  welcomed 
in  a home.  Avoid  needless  expense.  Try  to  be  resource- 
ful and  make  the  best  of  the  things  you  find  at  hand. 

Get  important  things  done  punctually  at  the  time 
ordered  if  you  possibly  can.  Get  other  less  important 
things  done  when  you  can.  Give  way  to  the  patient  as 
to  the  time  for  baths  and  such  things  when  the  time 
does  not  matter. 

When  the  patient  is  getting  regular  meals,  be  sure  to 
see  that  she  (or  he)  is  fed  or  has  her  meal  served  before 


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going  to  your  own  meal.  Prepare  the  patient’s  tray 
yourself  and  serve  all  trays  and  food  as  daintily  as  pos- 
sible. 

Never  forget  to  be  loyal  to  the  doctor  and  do  every- 
thing possible  to  have  things  done  as  he  wishes.  Re- 
member that  confidence  in  the  physician  and  treatment 
is  a great  help  in  many  cases. 

Keep  your  patient^s  room  tidy  and  clean.  Lack  of 
neatness  about  the  nurse^s  own  person  and  lack  of  tidi- 
ness about  the  room  are  two  common  complaints  about 
practical  nurses. 

The  sick-room  is  no  place  to  display  the  latest  style 
of  hair-dressing.  It  is  no  place  for  ^^rats’^  or  puffs’^  or 
false  head  gear  of  any  kind.  The  sensible  nurse  will  show 
her  appreciation  of  the  fitness  of  things  by  leaving  them 
outside.  Neither  is  the  sick-room  a place  to  display 
unnecessary  jewelry,  or  lingerie. 

No  nurse  is  called  on  to  sacrifice  her  own  health  in 
devotion  to  the  patient.  She  owes  it  to  herself  as  well 
as  to  the  sick  one  to  keep  in  as  good  condition  for  work 
as  possible.  If  she  is  to  do  this  she  must  have  proper 
hours  for  sleep  and  a chance  to  get  away  from  the  sick- 
room every  day  for  a while.  The  obligation  to  arrange 
for  this  is  one  that  the  family  is  prone  to  overlook. 
Usually  the  nurse  can  ask  the  doctor  to  speak  to  them 
about  some  one  to  relieve  her  if  she  hesitates  to  do  so 
herself.  Nothing  more  quickly  unfits  a nurse  for  her 
best  work  than  loss  of  sleep.  She  will  of  course  try  to 
take  her  hours  off  duty  at  the  time  most  convenient 
for  the  family. 

Study  constantly  to  improve  your  methods.  Do  not 
rest  satisfied  that  if  you  have  done  satisfactory  work  in 
one  home,  therefore  you  know  enough.  Tliose  who 
expect  to  nurse  for  hire  should  l)e  always  on  the  alert 
to  add  to  their  knowledge  of  sick-room  methods  and 
reciuirements. 


CHAPTER  XXV. 


INVALID  COOKERY;  SELECTED  RECIPES. 

LEMONADE  OR  ORANGEADE 

Ingredients:  1 lemon  or  orange,  1/2  pint  of  water,  2 
tablespoonfuls  of  sugar,  1 tablespoonful  of  crushed  ice. 

Method, — Roll  lemon  or  orange  until  soft;  remove  juice, 
being  careful  to  exclude  seeds;  add  sugar;  mix;  add 
water;  mix  well;  pour  over  ice  and  serve  at  once.  May 
be  made  with  hot  water  if  desired. 

EFFERVESCING  LEMONADE 

Ingredients:  Same  as  above,  with  1/4  teaspoonful  of 
soda  added  just  before  serving. 

Method, — Stir  well;  serve  while  effervescing. 

FLAXSEED  LEMONADE 

Ingredients:  2 tablespoonfuls  of  whole  flaxseed,  1 table- 
spoonful of  sugar,  2 tablespoonfuls  of  crushed  ice,  1 quart 
of  hot  water,  juice  of  1 lemon. 

Method, — Look  over  and  wash  flaxseed;  pour  boiling 
water  over  the  seed  and  steep  (do  not  boil)  for  two  hours; 
strain;  add  lemon  juice  and  sugar;  cool,  and  pour  over  ice. 

May  be  served  hot  if  desired. 

ALBUMEN-WATER 

Ingredients:  White  of  1 egg,  1/2  lemon  or  orange, 
2 tablespoonfuls  of  crushed  ice,  a little  sugar,  water 
enough  to  fill  glass. 

Method. — Beat  egg  slightly;  add  lemon  juice  and  sugar; 
strain  through  fine  strainer  over  ice;  mix  well;  fill  glass 
with  water  and  serve. 


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TOAST-WATER 

Ingredients:  1 thick  slice  of  bread,  1/4  teaspoonful  of 
salt,  1 cupfull  of  hot  water. 

Method. — Cut  bread  in  cubes;  toast  brown  in  oven; 
pour  water  over  toast;  add  salt;  let  stand  covered  until 
cool;  strain;  serve  either  hot  or  cold. 

SLIPPERY-ELM  TEA 

Ingredients:  2 teaspoonfulls  of  slippery-elm  powder  or  a 
piece  of  slippery-elm  bark  (about  2 ounces),  1 cupful 
of  hot  water,  1 tablespoonful  of  sugar,  1 teaspoonful  of 
lemon  juice. 

Method. — Pour  hot  water  over  powder;  let  stand  cov- 
ered until  cool;  strain;  add  sugar  and  lemon  juice;  serve 
either  hot  or  cold.  If  bark  is  used,  steep  one-half  hour 
before  straining. 

BEEF-TEA 

Ingredients:  1 pound  of  lean  beef,  1 pint  of  cold  water, 
1/2  teaspoonful  of  salt. 

Method. — Wipe  meat  with  damp  cloth;  cut  in  1/2  inch 
cubes;  put  in  quart  jar;  add  salt  and  water;  cover,  keep 
in  cool  place  for  four  hours  until  juices  are  well  started, 
then  place  jar  in  pan  of  cold  water  on  back  of  stove  and 
bring  slowly  to  a boil;  strain  and  serve.  It  may  be 
served  hot  or  frozen  if  desired. 

BEEF  JUICE 

Ingredients:  1/2  pound  of  lean  beef  (round  steak  is 
best),  1/4  teaspoonful  of  salt. 

Method. — Wipe  meat  with  damp  cloth,  place  in  wire 
broiler;  heat  over  hot  fire,  but  do  not  brown;  cut  in  small 
pieces;  press  through  meat  press  (always  heat  the  press 
and  bowl);  add  salt;  serve  in  colored  glass.  If  meat 
press  is  not  to  be  had  the  meat  may  be  pressed  in  a 
small  colander  using  a heavy  flat  iron  on  a saucer, 
letting  it  stand  over  night. 


INVALID  cookery;  SELECTED  RECIPES  255 

If  meat  is  heated  in  a frying  pan,  a bay  leaf  or  celery 
stalk  may  be  heated  with  it,  giving  it  a different  flavor. 
Beef  juice  may  be  made  like  beef-tea  by  omitting  water. 

COFFEE  AND  EGG 

Ingredients:  Yelk  of  1 egg,  1/2  cupful  of  hot  coffee,  1/2 
cupful  of  hot  milk. 

Method, — To  the  well-beaten  yelk  add  coffee  and  milk. 

COCOA 

Ingredients:  2 teaspoonfuls  of  cocoa,  1 teaspoonful  of 
sugar,  2 teaspoonfuls  of  hot  water,  1 cupful  of  hot  milk. 

Method. — Mix  cocoa  and  sugar;  add  hot  water;  stir 
until  dissolved;  add  milk  and  bring  to  a boil;  beat  with 
a Dover  egg-beater  until  it  foams  or  place  a spoonful  of 
whipped  cream  on  top  of  cup  before  serving  it;  serve  hot. 

WHEY 

Ingredients:  1 pint  of  milk,  2 teaspoonfuls  of  essence 
of  pepsin. 

Method. — Heat  milk  to  100®  F.;  add  pepsin;  whip 
lightly  with  a fork  to  separate  the  curd;  strain  through  a 
fine  strainer.  Serve  cold. 

MILK-PUNCH 

Ingredients:  1/2  pint  of  milk,  2 teaspoonfuls  of  sugar,  2 
tablespoonfuls  of  brandy  or  sherry. 

Method. — Dissolve  sugar  in  milk;  add  brandy;  mix 
well,  and  serve. 

EGG  BROTH 

Ingredients:  1 egg,  1/2  teaspoonful  of  sugar,  1 pint  of 
boiling  water,  1/2  teaspoonful  of  salt.  Milk  may  be  used 
instead  of  water  and  a small  piece  of  butter  added  if 
desired. 

Method. — Beat  egg  and  sugar  until  very  light;  add  boil- 
ing water,  stirring  all  the  time;  add  salt.  Serve  at  once* 


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EGG  FLIP 

Ingredients:  1 egg,  1/2  teaspoonful  of  sugar,  1 wine 
glassful  of  sherry  or  brandy  if  ordered  by  doctor. 

Method. — Beat  yelk  of  egg  and  sugar  until  light  and 
creamy;  add  spirits;  beat  white  of  egg  till  stiff;  fold  into 
mixture.  Serve  at  once.  Two  tablespoonfuls  of  lemon 
juice  may  be  used  instead  of  spirits. 

EGG-NOGG 

Ingredients:  1 egg,  1 tablespoonful  of  sugar,  1 cupful 
of  milk,  1 teaspoonful  of  vanilla  or  1 tablespoonful  of  wine 
or  whiskey,  1 tablespoonful  of  crushed  ice. 

Method. — Beat  egg  yelk  and  sugar  until  light;  add 
milk;  fold  in  stiffly  beaten  white;  add  flavoring;  mix  well; 
pour  over  crushed  ice  and  serve.  If  wine  is  used,  add 
ice-water  before  adding  milk.  May  be  served  hot  by 
omitting  white  of  egg  and  heating  milk. 

PEPTONIZED  MILK 

Ingredients:  1/2  pint  of  milk,  1 gill  of  water,  1 small 
tablespoonful  of  liquor  pancreaticus,  20  grains  of  soda. 

Method. — Add  water  to  milk;  heat  to  140^  F.  (without 
boiling) ; add  other  ingredients;  place  in  bottle;  cork  with 
absorbent  cotton;  keep  in  warm  place  for  one  hour,  then 
bring  to  a boil.  Boiling  arrests  the  fermentation. 

MILK  COFFEE 

Ingredients:  1 tablespoonful  of  ground  coffee,  1/2  cup- 
ful of  cold  water,  1 cupful  of  hot  milk. 

Method. — Put  coffee  in  coffee-pot;  add  water;  bring  to 
a boil;  let  stand  for  five  minutes;  strain;  add  hot  milk. 
Serve  at  once. 

MALTED  MILK  (COLD) 

Ingredients:  1 tablespoonful  of  malted  milk,  3/4  cup- 
ful of  cold  water,  1 talilespoonful  of  hot  water. 

Method. — Dissolve  malted  milk  in  hot  water;  add  cold 
water;  stir  until  well  mixed  or  place  in  a soda-water 


INVALID  cookery;  SELECTED  RECIPES  257 


shaker  and  shake  until  dissolved.  A tablespoonful  of  hot 
coffee,  cocoa,  or  flavoring  of  any  kind  desired  may  be 
used. 


MALTED  MILK  ICE-CREAM 

Ingredients:  2 1/2  tablespoonfuls  of  malted  milk,  1 
cupful  of  water,  1 tablespoonful  of  sugar,  1 tablespoonful 
of  cream,  1/2  teaspoonful  of  flavoring. 

Method, — Mix  milk  and  sugar;  dissolve  in  water;  add 
cream  and  flavoring;  stir  well;  freeze.  White  of  an 
egg  (stiffly  beaten)  may  be  added  if  a richer  cream  is 
desired. 


CREAMED  EGG 

Ingredients:  1 egg,  1/4  cupful  of  milk,  1/2  tablespoon- 
ful of  butter,  1/4  teaspoonful  of  salt,  1 slice  of  toast. 

Method, — Beat  egg  slightly;  add  salt;  heat  milk  and 
butter  in  double  boiler;  add  egg;  cook  until  creamy  (about 
three  minutes,  stirring  all  the  time) ; toast  bread  a golden 
brown;  remove  crust;  place  egg  on  toast.  Serve  at  once. 
Garnish  with  cress. 

EGG  IN  BATTER,  OR  SCALLOPED  EGG 

Ingredients:  1 egg,  2 tablespoonfuls  of  cream,  2 table- 
spoonfuls of  bread-crumbs,  1/4  teaspoonful  of  salt. 

Method, — Mix  cream,  bread-crumbs,  and  salt.  Butter 
an  egg-cup;  put  one-half  the  mixture  in  cup,  then  the  egg, 
cover  with  the  remainder  of  mixture;  bake  five  or  six 
minutes  in  a moderate  oven.  Serve  at  once  in  cup  used 
for  baking. 


SHIRRED  OR  BAKED  EGG 

Method, — Break  egg  in  buttered  dish;  add  salt;  bake 
in  moderate  oven  until  white  is  firm  (about  five  minutes) . 
Serve  in  same  dish.  Garnish  with  strips  of  bread  and 
butter. 


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SCRAMBLED  EGGS  ON  TOAST 

Ingredients:  1 egg,  1 tablespoonful  of  milk,  1 teaspoon- 
ful of  butter,  1/8  teaspoonful  of  salt,  1 slice  of  toast. 

Method. — Beat  egg  slightly;  add  milk  and  salt;  melt 
butter  in  frying  pan;  add  mixture;  cook  until  creamy, 
stirring  very  gently.  If  rightly  managed,  it  will  be  soft, 
creamy,  and  toothsome;  if  wrongly,  tough  and  stringy. 
Toast  bread  a golden  brown;  roll  crust;  butter  and  mois- 
ten slightly;  pour  egg  on  toast;  garnish  with  parsley. 
Serve  at  once. 

EGG  SOUFFLE 

Method. — Separate  white  and  yelk;  beat  white  till  stiff; 
place  in  heavy  tumbler;  add  salt;  place  glass  in  pan;  add 
warm  water;  place  cloth  in  pan  to  set  glass  on;  have  the 
water  about  three-quarters  up  the  glass;  bring  to  a boil; 
cook  until  white  rises  to  top  of  glass;  make  a depression 
in  the  center;  drop  the  yelk  in  very  carefully  so  as  not  to 
break;  cook  about  two  minutes  or  until  the  yelk  is  set; 
remove  and  serve  at  once,  with  strips  of  bread  and  butter. 

OMELET 

Ingredients:  1 egg,  1 tablespoonful  of  butter,  1 table- 
spoonful of  milk,  1 tablespoonful  of  bread-crumbs,  1/4 
teaspoonful  of  salt,  a dash  of  pepper. 

Method. — Separate  egg;  beat  white  till  stiff;  cream 
yelk;  add  to  bread-crumbs  and  milk;  mix;  add  salt;  fold  in 
stiffly  beaten  white;  place  butter  in  well-cleaned  omelet 
pan;  heat;  add  mixture;  cook  on  top  of  stove  slowly  until 
well  risen;  place  on  rack  of  oven  until  firm;  remove  care- 
fully to  a hot  plate;  garnish  with  parsley.  Serve  at  once. 
May  be  varied  by  using  minced  chicken  or  meat  of  any 
kind,  or  vegetables  in  place  of  bread-crumbs. 

EGG  NESTS 

Ingredients:  2 eggs,  2 slices  of  toast. 

Method. — Divide  the  whites  and  yelks  of  the  eggs,  being 
careful  to  keep  the  yelks  unbroken;  have  the  toast  buttered 


A dish  of  nuts  (Good  Health). 


Devilled  eggs  (Good  Health). 


INVALID  cookery;  SELECTED  RECIPES  259 

and  cut  in  rounds.  It  may  be  moistened  with  a little 
soup  stock  if  desired.  Use  only  one-half  the  whites  of  the 
eggs;  beat  to  a stiff  froth  and  heap  on  the  rounds  of  toast. 
With  the  ends  of  the  shell  make  a hollow  in  the  center  of 
the  mound,  drop  in  the  yolk,  sprinkle  with  salt  and  pep- 
per. Drop  on  some  tiny  pieces  of  butter  and  set  on  the 
top  shelf  of  an  oven  not  too  hot.  Allowance  should  be 
made  for  the  egg  to  be  in  the  oven  at  least  four  minutes 
before  browning.  The  toast  may  be  sprinkled  with 
grated  cheese  or  finely  minced  meat.  Tomato  sauce 
may  also  be  served  with  it. 

RICE  OMELET 

Ingredients:  1/3  teacupful  of  cold  boiled  rice,  1/3  cup- 
ful of  milk,  1 teaspoonful  of  melted  butter,  1 egg,  salt  as 
needed. 

Method. — Warm  the  cold  boiled  rice  in  the  milk  and 
add  the  melted  butter;  beat  yelk  and  white  of  egg  sepa- 
rately; stir  the  yelk  into  the  other  ingredients,  and,  lastly, 
fold  in  stiffly  beaten  whites;  pour  into  a very  hot,  well 
buttered,  individual  frying  pan;  let  it  brown  for  one 
minute;  put  on  the  top  of  the  oven  to  set  the  top,  and 
fold  and  serve  as  usual. 

PLAIN  OMELET 

Method. — Put  2 eggs  into  bowl;  add  salt  and  pepper  as 
desired;  beat  vigorously  for  twelve  minutes  with  fork, 
and  add  1 tablespoonful  of  milk  or  cream. 

Into  a small  hot  frying  pan  put  a teaspoonful  of  butter; 
pour  in  the  egg  and  shake  over  the  fire  till  it  is  set;  roll, 
and  serve  on  a hot  dish.  Grated  cheese  or  minced 
chicken  or  ham  may  be  spread  over  before  rolling  it. 

CLAM  BROTH 

Ingredients:  1/2  dozen  of  fresh  clams,  1 cupful  of  water, 
1 cupful  of  milk,  1/2  teaspoonful  of  salt,  a bit  of  butter,  a 
dash  of  pepper. 

Method. — Wash  clams;  cut  in  small  pieces;  add  water 


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and  salt;  bring  to  a boil;  skim;  add  milk,  butter,  pepper; 
bring  to  boil;  strain  if  patient  may  not  have  the  clam 
meat.  Serve  hot  with  toast  or  crackers. 

OYSTER  BROTH 

Ingredients:  1/2  cupful  of  oysters,  1 cupful  of  water, 
1/4  teaspoonful  of  salt,  a dash  of  pepper,  or  1 cupful  of 
white  sauce. 

Method. — ^Wash  oysters,  place  in  saucepan;  heat;  skim; 
add  water,  salt,  and  pepper;  bring  to  boil.  Serve  very 
hot  with  oysterettes. 

Oyster  stew  is  made  without  cutting  the  oysters,  and 
using  milk,  crumbs,  crackers  and  1 teaspoonful  of  butter. 
Serve  hot,  as  above. 

BEEF  OR  MUTTON  BROTH 

Ingredients:  2 pounds  of  lean  beef  or  mutton  (shank 
of  beef  or  neck  of  mutton),  2 quarts  of  cold  water,  1 tea- 
spoonful of  salt,  3 tablespoonfuls  of  rice  or  barley,  2 bay 
leaves,  1 stalk  of  celery. 

Method. — Wipe  meat  with  damp  cloth;  remove  fat  and 
skin,  cut  in  pieces;  break  the  bones;  place  all  in  soup 
kettle;  add  salt  and  cold  water;  heat  gradually  to  the 
boiling-point,  but  do  not  boil;  skim  as  scum  rises  to  the 
top;  simmer  for  three  or  four  hours;  strain;  cool;  remove 
all  fat;  add  rice,  celery,  bay  leaf,  and  cook  until  rice  is 
soft,  but  do  not  boil.  Serve  hot  with  croutons  or  wafers. 

CHICKEN  JELLY 

Ingredients:  1/2  chicken  or  fowl,  1 quart  of  cold  water, 
1/4  bunch  of  parsley,  1 teaspoonful  of  salt,  2 stems  of 
celery. 

Method. — Clean,  wash,  and  skin  chicken;  cut  in  small 
pieces,  l)eing  sure  to  use  all  the  bones;  place  in  stew  pan; 
add  celery,  the  stems  of  the  parsley,  but  not  the  leaves; 
salt;  pour  cold  water  over  all;  simmer  (do  not  boil)  until 
the  chicken  falls  to  pieces;  strain;  stand  over  night  or 
until  cold;  remove  fat.  Should  be  clear,  firm  jelly. 


INVALID  cookery;  SELECTED  RECIPES  261 


CHICKEN  MILK 

Ingredients:  1 cupful  of  chicken  jelly,  1 cupful  of  milk. 
Method, — Place  in  stew  pan  and  bring  to  boil.  Serve 
hot  with  strips  of  toast,  or  may  be  served  cold  in  jelly 
form. 


TAPIOCA  CREAM  SOUP 

Ingredients:  1 pint  of  stock,  1 cupful  of  cream  or 

milk,  1 heaping  tablespoonful  of  tapioca,  1 small  onion, 
1 stalk  of  celery,  2 teaspoonfuls  of  butter. 

Method, — Wash  and  soak  the  tapioca  and  cook  in  just 
sufficient  water  to  keep  from  burning  for  one  hour; 
cut  onion  and  celery  into  small  pieces  and  cook  for 
twenty  minutes  in  the  stock,  add  the  milk  to  the  stock; 
stir  in  the  tapioca;  add  butter,  salt,  and  pepper;  simmer 
slowly  until  tapioca  is  thoroughly  cooked. 

CREAM  OF  TOMATO 

Ingredients:  2 tablespoonfuls  of  tomato  juice,  1/2  cup- 
ful of  milk,  1 tablespoonful  of  flour  or  bread-crumbs,  1 
tablespoonful  of  butter,  1/4  teaspoonful  of  salt,  1/8  tea- 
spoonful of  soda,  a dash  of  pepper. 

Method. — Heat  tomato  juice;  add  soda;  heat  milk; 
add  butter,  flour,  salt,  and  pepper.  When  ready, 
serve  at  once  with  croutons  or  crackers. 

CREAM-TOAST 

Ingredients:  3 small  slices  of  bread  toasted,  I tea- 
spoonful of  butter,  1 tablespoonful  of  cornstarch,  1 cup- 
ful of  milk,  1/2  teaspoonful  of  salt. 

Method. — Have  the  toast  buttered;  cut  in  small 
squares  with  crust  rolled  or  removed;  place  it  in  hot 
deep  basin  or  soup  plate;  let  the  milk  come  to  a boil  and 
add  the  butter;  blend  the  cornstarch  with  a little  water; 
stir  it  into  the  milk  and  cook  for  five  minutes  in  a double 
boiler,  stirring  until  smooth.  Pour  over  the  toast  and 
serve  at  once. 


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MlLK-TOAST 

Method. — Toast  2 slices  of  bread  evenly;  cut  in  neat 
squares,  removing  the  crust,  and  place  in  a deep  basin, 
which  should  first  be  heated;  have  ready  also  a hot 
saucer  or  plate  to  cover  it;  prepare  the  tray  with  a small 
knife,  fork,  and  teaspoon,  a little  silver  pot  of  hot  milk, 
a ball  of  butter,  and  a salt  shaker.  If  the  patient  is 
able  to  butter  his  own  toast  and  pour  the  hot  milk,  he 
will  usually  enjoy  doing  it.  If  not,  the  toast  should  be 
buttered  and  the  milk  added  when  ready  to  be  eaten. 
Bouillon  or  consomme  may  be  used  instead  of  milk. 

CLAM-TOAST 

Method. — Chop  a dozen  small  clams  into  small  pieces 
and  simmer  for  a few  minutes;  beat  the  yelk  of  1 egg  with 
2 tablespoonfuls  of  milk;  pour  it  over  the  clams;  let  it 
come  almost  to  the  boiling-point  and  pour  over  hot 
buttered  toast.  Lean  ham  may  be  minced,  cooked, 
and  served  in  the  same  way,  a little  butter  and  chopped 
parsley  being  used  for  seasoning. 

GELATIN  FRUIT  PUDDING 

To  a plain  lemon  jelly,  when  beginning  to  set,  add 
sliced  fruit,  as  oranges,  pineapples,  peaches,  bananas, 
white  grapes,  strawberries.  Or  the  fruit  may  be  placed 
in  layers  and  the  gelatin  poured  over  and  left  to  set  and 
then  another  layer  of  fruit  added.  Set  in  cold  place 
until  firm.  Serve  cold  with  cream  or  soft  custard. 

SPANISH  CREAM 

Ingredients:  1 tablespoonful  of  granulated  gelatin, 
2 tablespoonfuls  of  cold  water,  1 cupful  of  milk,  2 table- 
spoonfuls of  sugar,  1/2  teaspoonful  of  vanilla,  2 eggs, 
1/8  teaspoonful  of  soda. 

Method. — Soak  gelatin  five  minutes  in  cold  water; 
heat  the  milk;  add  soda,  sugar,  and  beaten  yelks;  stir 
until  it  thickens;  pour  over  gelatin,  stir  until  cold;  add 


Bouillon  and  arrowroot  blanc  mange. 


Strawberries  and  a cream  puff 


Calf  s foot  jelly  and  other  things. 


■ librarv 

OF  THE 

ONIVERSITy  OF  ILLINOIS 


INVALID  cookery;  SELECTED  RECIPES  263 

stiffly  beaten  whites  and  vanilla;  pour  over  sliced  fruit 
as  bananas,  oranges,  fresh  berries;  set  in  cold  place  until 
firm.  Serve  cold  with  whipped  cream  or  boiled  custard. 

RICE  AND  APPLE  SOUFFLE 

Ingredients:  1 tablespoonful  of  rice,  1 cupful  of  milk, 
1 tart  apple,  1 egg,  1 tablespoonful  of  sugar. 

Method. — Wash  rice;  cook  in  double  boiler  until 
tender;  add  well-beaten  yelk  and  sugar;  place  in  border 
mold;  pare  and  core  apple;  cook  until  tender.  When 
rice  is  firm,  turn  on  cold  plate,  place  apple  in  center, 
and  fill  core  cavity  with  jelly;  cover  all  with  stiffly 
beaten  whites;  place  in  oven  until  a golden  brown. 
Serve  with  cream  and  sugar. 

ARROWROOT  BLANC  MANGE 

Ingredients:  1 cupful  of  milk,  2 tablespoonfuls  of 
arrowroot,  2 teaspoonfuls  of  sugar,  1/4  teaspoonful  of 
vanilla,  1 pinch  of  salt. 

Method. — Place  milk  in  double  boiler;  heat;  add 
arrowroot  and  sugar  mixed  to  a paste  with  cold  water; 
stir  until  it  thickens;  remove  from  fire;  add  salt  and 
flavoring;  pour  in  mold;  set  in  cold  place  until  firm. 
Serve  cold  with  whipped  cream.  Garnish  with  candied 
cherries.  Lady  fingers  may  be  served  with  it. 

FLOATING  ISLAND 

Ingredients:  1 cupful  of  milk,  1 tablespoonful  of  sugar, 
1/8  teaspoonful  of  flavoring,  a dash  of  salt,  1 teaspoonful 
of  powdered  sugar,  1 egg,  1/4  teaspoonful  of  cornstarch. 

Method  for  the  Custard. — Heat  the  milk  in  double 
boiler;  add  sugar  and  salt;  take  from  fire;  add  well-beaten 
egg  yelk,  stir  until  it  thickens;  add  flavoring;  turn  into 
a glass  dish  and  set  in  cold  place. 

Method  for  the  Island. — Beat  white  of  egg  till  very 
stiff;  add  powdered  sugar;  drop  islands  (about  1/2  tea- 
spoonful) on  buttered  paper;  place  in  oven  for  a minute; 
then  place  on  top  of  custard. 


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FRUIT  SOUFFLE 

Ingredients:  1 cupful  of  stewed  fruit,  1/4  cupful  of  sugar, 
white  of  1 egg,  1/4  teaspoonful  of  flavoring. 

Method. — Cook  fruit  until  very  tender;  strain  through 
coarse  strainer;  add  sugar  and  flavoring;  cool;  then  fold 
in  stiffly  beaten  white;  set  in  cold  place;  serve  cold. 
Any  fruit  may  be  used,  either  dried  or  fresh — apples, 
peaches,  prunes,  apricots,  berries. 

IMPERIAL  CREAM 

Make  a plain  lemon  jelly;  divide  in  thirds;  color  one- 
third  pink  and  turn  into  square  mold;  mold  the  plain 
lemon  jelly  in  a square  mold;  make  a snow  pudding  of 
the  other  third.  When  nearly  ready  to  harden,  drop 
lemon  and  pink  jelly,  cut  in  inch  cubes,  into  snow 
pudding;  place  in  mold;  set  in  cold  place.  Serve  on 
cold  dish.  Garnish  with  macaroons.  Pour  boiled  cus- 
tard over  and  serve. 


PRUNE  SPONGE 

Ingredients:  Juice  of  1 lemon,  1/4  cupful  of  sugar, 
2 eggs,  1 tablespoonful  gelatin,  1 cupful  of  water,  1 
cupful  of  jellied  prunes. 

Method. — Heat  juice  of  lemon;  add  sugar;  stir  until 
dissolved;  add  well-beaten  yelks;  stir  until  thick;  pour 
over  dissolved  gelatin;  fold  in  stiffly  beaten  whites;  pour 
into  border  molds;  set  in  cold  place  until  firm;  turn 
on  cold  dish;  fill  center  with  jellied  prunes.  Serve  with 
whipped  cream. 


JELLIED  PRUNES 

Ingredients:  1/2  cupful  of  dried  prunes,  1/4  cupful  of 
sugar,  1 cupful  of  water. 

Method. — Wash  prunes  very  thoroughly;  soak  over 
night;  cook  on  back  of  stove  where  they  will  not  boil 
until  tender;  remove  stones  and  drop  into  hot  syrup; 
bring  to  boil;  set  aside  until  wanted.  Use  as  directed 
above. 


INVALID  cookery;  SELECTED  RECIPES  265 

PRUNE  WHIP 

Ingredients:  1 cupful  of  cooked  prunes,  white  of  1 egg, 
1 tablespoonful  of  sugar,  1 tablespoonful  of  lemon  juice. 

Method. — Strain  prunes  through  coarse  sieve,  removing 
stones;  add  lemon  juice;  fold  in  stiffly  beaten  white;  add 
sugar;  pile  on  buttered  plate;  stand  in  oven  for  about 
one  minute  or  until  set.  Serve  cold  with  whipped  cream 
or  thin  boiled  custard. 

GRAPE  FLUFF 

Ingredients:  1 tablespoonful  of  granulated  gelatin, 
1/4  cupful  of  cold  water,  1/2  cupful  of  sugar,  1 cupful  of 
grape  juice,  juice  of  1 lemon,  white  of  3 eggs. 

Method. — Soak  gelatin  in  cold  water  five  minutes; 
dissolve  by  standing  over  steam;  add  sugar  to  grape 
juice;  stir  until  dissolved;  add  gelatin  and  lemon  juice; 
mix  well;  stand  in  cold  place  until  it  begins  to  thicken, 
then  add  stiffly  beaten  whites;  beat  until  light  and  stiff. 
Serve  cold  with  whipped  cream. 

BAKED  BANANA 

Peel  and  cut  banana  in  half;  place  in  a shallow  pan; 
sprinkle  with  sugar,  a little  lemon  juice,  and  water; 
bake  under  cover  until  soft  and  light  brown  (about 
twenty  minutes) . 

GRAPE  FRUIT 

Cut  in  half,  crosswise;  separate  pulp  from  skin,  then 
make  cuts  separating  pulp  from  tough  portion;  remove 
tough  part;  sprinkle  with  sugar;  let  stand  in  cold  place 
ten  minutes.  Serve  garnished  with  a few  candied 
cherries. 

BANANA  CUSTARD 

Make  a rich  soft  custard  with  yelk  of  egg,  milk,  and 
cornstarch,  using  any  flavoring  desired;  peel  a banana, 
cut  in  thin  slices,  and  line  the  bottom  and  sides  of  the 
glass  dish  in  which  the  custard  is  to  be  served;  beat  the 


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white  of  the  egg  to  a stiff  froth;  drop  in  molds  on  top 
of  the  custard;  put  in  oven  for  a moment  to  set  the 
white,  and  serve  cold.  If  desired  the  bananas  may  be 
moistened  with  lemon  juice. 

APPLE  SNOW 

Put  a cupful  of  fresh  apple-sauce  through  a colander 
to  remove  any  stringy  portions;  sweeten  and  flavor  to 
taste;  whip  1/2  cupful  of  sweet  cream  and  the  white  of  an 
egg  separately,  then  together,  and  add  the  apple;  pour 
into  mold  and  set  on  ice  until  needed. 

LEMON  ICE 

Ingredients:  1/4  cupful  of  sugar,  1 cupful  of  water,  1/4 
cupful  of  lemon  juice. 

Method. — Make  a syrup  of  the  sugar  and  water,  boiling 
about  five  minutes.  Skim  if  necessary;  cool;  add  lemon 
juice,  strain,  and  freeze. 

Orange  ice  is  made  by  using  oranges  in  place  of  the 
lemons,  or  any  fruit  juice  may  be  used.  Sherbet  is 
made  by  adding  the  beaten  white  of  egg  or  1 teaspoonful 
of  dissolved  gelatin  when  half  frozen.  If  only  softly 
frozen  it  is  called  frappe;  punch,  if  fruit  is  added. 

PHILADELPHIA  ICE-CREAM 

Ingredients:  1 cupful  of  cream,  2 tablespoonfuls  of 
sugar,  1/4  teaspoonful  of  vanilla  extract  or  one-quarter  of 
a vanilla  bean. 

Method. — Place  half  of  the  cream  in  a double  boiler; 
add  sugar  and  vanilla;  cook  until  sugar  is  dissolved, 
stirring  constantly;  strain  and  cool;  add  the  rest  of 
cream  and  freeze.  Any  flavoring  may  be  used.  If  the 
fruit  cream  is  desired,  use  the  same  amount  of  fruit  as 
cream,  and  proceed  as  above. 

FROZEN  CUSTARD 

Ingredients:  1 cupful  of  milk,  1 tablespoonful  of  sugar, 
yelks  of  2 eggs,  1 /4  teaspoonful  of  vanilla,  a pinch  of  salt, 
1 teaspooiiful  of  cornstarch. 


INVALID  cookery;  SELECTED  RECIPES  267 

Method. — Place  milk  in  double  boiler;  add  sugar  and 
cornstarch,  well  mixed,  stir  until  it  begins  to  thicken; 
remove  from  fire;  add  flavoring  and  well-beaten  egg; 
stir  until  mixed;  strain,  cool,  and  freeze.  These  two 
rules  are  the  foundation  for  all  ice-cream.  Add  fruit 
and  it  is  called  tutti  frutti;  nuts,  and  it  is  called  pistachio. 
Coffee  may  be  used  in  place  of  half  of  the  milk.  Different 
flavors  give  the  name  to  the  cream. 

CHARLOTTE  RUSSE 

Ingredients:  1 cupful  of  cream,  1 tablespoonful  of  sugar, 
1/4  teaspoonful  of  vanilla,  1/2  dozen  lady  Angers,  1 
tablespoonful  of  granulated  gelatin,  white  of  1 egg,  1/2 
cupful  of  water. 

Method. — Dissolve  gelatin  in  water;  whip  cream  after 
adding  sugar  and  flavoring;  when  stiff,  add  stiffly  beaten 
white  of  egg  and  gelatin  and  beat  well;  line  with  lady 
fingers;  pour  mixture  in  center;  set  in  cool  place. 

BAVARIAN  CREAM 

Ingredients:  1 tablespoonful  of  grated  chocolate,  1 
cupful  of  milk,  1 tablespoonful  of  sugar,  1 tablespoonful 
of  granulated  gelatin,  2 tablespoonfuls  of  cold  water,  1/2 
pint  of  whipped  cream,  1/2  teaspoonful  of  vanilla. 

Method. — Dissolve  chocolate;  place  milk  in  double 
boiler;  add  chocolate  and  sugar;  heat  to  boiling-point; 
remove  from  fire;  add  extract;  pour  over  dissolved  gelatin; 
set  in  cold  place  until  it  hardens;  then  fold  in  whipped 
cream;  pour  in  mold;  set  in  cold  place  until  firm.  Serve 
very  cold.  Any  fruit  juice  desired  may  be  used  in  place 
of  chocolate. 

A pretty  way  to  serve  ice-cream  is  to  bake  angel  cake 
in  cups.  When  cold,  remove  the  inside;  fill  with  cream; 
make  handles  of  spaghetti,  softened  in  hot  water,  formed 
in  loops,  and  dried;  stick  in  sides  of  cake,  making  a 
basket;  place  a candied  cherry  on  top.  Serve  on  cold 
plate.  Garnish  with  rose  leaves  and  buds. 


268 


HOME  NURSE^S  HAND-BOOK 


STRAWBERRY  BLANC  MANGE 

Ingredients:  1 cupful  of  milk,  1 teaspoonful  of  corn- 
starch, 1 tablespoonful  of  sugar,  1/2  teaspoonful  of 
flavoring,  1 egg,  1 cupful  of  berries  (fresh  are  best). 

Method. — Heat  milk  in  double  boiler;  add  cornstarch 
and  sugar,  well  mixed;  stir  until  it  thickens;  remove 
from  fire;  add  well-beaten  egg  and  flavoring,  stirring 
until  well  mixed;  pour  in  border  molds;  set  in  cold  place 
until  firm;  turn  out  on  cold  plate;  fill  center  with  the  well- 
washed  berries.  Serve  cold  with  whipped  cream  or  boiled 
custard.  Flavoring  with  chocolate  or  filling  the  center 
with  bananas  make  agreeable  changes. 

ORANGE  PUDDING 

Slice  a sweet  orange  thin  after  peeling;  remove  seeds; 
cover  with  sugar.  Pour  boiled  custard  over  orange; 
make  a meringue;  place  over  all;  set  in  oven  until  firm 
(about  two  minutes) . Serve  cold. 

Do  not  let  the  orange  heat,  as  it  will  become  bitter. 

LEMON  JELLY  AND  SNOW  PUDDING 

Ingredients:  2 tablespoonfuls  of  granulated  gelatin, 
2 tablespoonfuls  of  cold  water,  1 tablespoonful  of  sugar, 
1 tablespoonful  of  lemon  juice,  1 cupful  of  hot  water. 

Method. — Soak  gelatin  in  cold  water  five  minutes; 
add  boiling  water,  stirring  all  the  time;  add  sugar  and 
lemon  juice;  pour  in  mold;  set  in  cold  place  until  firm. 
By  adding  the  stiffly  beaten  white  of  an  egg  just  as  it 
begins  to  harden,  beating  until  stiff  and  white,  it  makes 
what  is  called  snow  pudding.  Put  on  ice.  Serve  on  cold 
dishes  with  whipped  cream  or  custard. 

TAPIOCA  CREAM 

Ingredients:  1 teaspoonful  of  pearl  tapioca,  1 cupful 
of  milk,  1 tablespoonful  of  sugar,  1 egg,  1 /8  teaspoonful  of 
salt,  1/4  teaspoonful  of  flavoring. 

Method. — Wash  and  soak  tapioca  in  cold  water  over 


Orange  salad  (Good  Health). 


Tomato  salad  (Good  Health). 


Cottage  cheese  salad  (Good  Health). 


LIBRARY 
OF  THE 

UNIVERSITY  0;  1LL1!‘.C!S 


INVALID  cookery;  SELECTED  RECIPES  269 


night;  drain;  place  in  double  boiler;  add  milk,  sugar,  and 
salt;  cook  until  it  thickens;  remove  from  fire;  add  flavor- 
ing and  well-beaten  egg  yelk;  turn  into  serving  dish; 
cover  with  a meringue  made  of  the  stiffly  beaten  white; 
place  in  oven  until  golden  brown.  May  be  served  either 
cold  or  hot.  A few  chopped  dates  may  be  added  when 
desired. 


BANANA  CREAM 

Ingredients:  1 banana,  1/2  cupful  of  cream,  1 teaspoon- 
ful of  sugar,  1 teaspoonful  of  gelatin,  a few  drops  of 
vanilla. 

Method, — ^Peel  and  mash  banana;  dissolve  gelatin  in 
cold  water;  add  mashed  banana,  sugar,  cream,  and 
vanilla;  mix  well;  add  dissolved  gelatin;  turn  into  mold; 
set  in  cold  place  until  firm.  Serve  cold  with  sponge  cake. 

COTTAGE  PUDDING 

Ingredients:  1/2  cupful  of  sugar,  1/4  cupful  of  milk,  1/4 
cupful  of  butter,  11/2  cupfuls  of  flour,  1 egg,  1 teaspoon- 
ful of  baking  powder,  1/2  teaspoonful  of  flavoring  or  1/2 
teaspoonful  of  grated  nutmeg. 

Method. — Cream  sugar  and  butter;  add  well-beaten 
egg  and  milk,  then  flavoring  and  flour,^  with  baking 
powder  sifted  together;  place  in  buttered  pan;  bake  in 
moderate  oven  about  one-half  hour  or  until  done;  cut 
in  squares.  Serve  with  lemon  sauce. 

SCRAPED  BEEF-BALLS 

Method. — Scrape  steak  until  all  the  soft  part  is  removed; 
add  salt;  make  into  balls  about  the  size  of  marbles;  pan- 
broil as  directed  for  pan-broiled  steak  for  about  two  or 
three  minutes.  Serve  on  hot  plate.  Garnish  with 
parsley. 

PANNED  OYSTERS 

Ingredients:  1 cupful  of  oysters,  1 teaspoonful  of  butter, 
1/2  teaspoonful  of  salt,  a dash  of  pepper. 


270 


HOME  nurse’s  hand-book 


Method, — Wash  oysters;  drain;  place  in  saucepan;  heat 
until  the  oysters  are  plump;  add  butter,  salt,  pepper; 
pour  over  toast.  Serve  at  once.  Garnish  with  bread 
sticks  piled  in  log-cabin  fashion  around  the  edge  of  the 
plate.  Serve  a slice  of  lemon  with  the  oysters  if  desired. 

BANANA  SALAD 

Peel  and  split  bananas;  roll  in  chopped  nuts  and  place 
on  crisp  lettuce  leaf.  Just  before  serving,  place  a spoon- 
ful of  cream  dressing  over.  Serve  with  small  cakes. 

MIXED  FRUIT  SALAD 

Three  or  more  kinds  of  fruit  may  be  used,  raw  or  can- 
ned; place  fruit  in  layers,  sprinkling  each  with  sugar; 
pour  cream  dressing  over;  let  stand  to  set;  before  serving, 
sprinkle  thickly  with  cocoanut.  Peaches,  oranges,  pine- 
apple, banana,  etc.,  may  be  used. 

ORANGE  SALAD 

Peel  large  sweet  orange  and  cut  in  thin  round  slices; 
place  a layer  in  the  bottom  of  the  dish,  cover  with  Mayon- 
naise dressing,  and  continue  to  alternate  the  layers, 
finishing  with  the  sliced  oranges.  This  is  a quickly  pre- 
pared, simple  relish  when  greens  or  other  salads  are  not 
available. 


COTTAGE-CHEESE  SALAD 

Ingredients:  1 cupful  of  cottage  cheese,  1/2  cupful  of 
chopped  celery,  1/2  cupful  of  French  dressing  or  cooked 
Mayonnaise,  1 hard-boiled  egg,  4 walnuts. 

Method. — Prepare  the  cheese  and  drain  thoroughly; 
arrange  the  cheese  in  the  dish  in  which  it  will  be  served 
on  lettuce  leaves  or  cress,  and  alternate  layers  of  finely 
chopped  celery,  the  walnut  meat,  and  a thin  slice  of  hard- 
boiled  egg. 


INDEX 


A 

Abdomen,  57,  108,  229,  244 
Abdominal  bandage,  172 
wound,  43 
Abrasions,  35,  163 
Acid,  boracic,  35,  203,  205 
carbolic,  35,  116,  156 
Administration  of  food,  77 
of  medicines,  121 
Ailment,  21 
Air,  12,  25,  133,  248 
Alcohol,  52,  61,  119 
sweat,  109 
Albumin,  69 
Antidotes,  35,  188 
Antiseptic,  151 
Appendicitis,  237 
Apoplexy,  185 
Appetite,  84,  214 
Arm,  52,  99 

B 

Babies,  128 

Baby,  care  of,  128,  197 

Bacteria,  15 

Bandages,  31,  32,  37,  59,  61,  170 
Basin,  99,  180 
Baths,  49,  51,  54,  98,  199 
baby’s,  130,  216. 
cleansing,  52 
cold  sponge,  98 
eye,  116 
foot,  79 
hot  air,  110 
spray,  101 


Bed,  38 

changing  of,  42 
clothing,  39 
making  of,  39 
protection  of,  38,  202 
wooden,  38 
Bed  pan,  31,  62,  226 
Bedside  report,  95 
Bed-sores,  60 

Bichloride  of  mercury,  23,  156^ 
210 

solution,  204 
Binder,  128 
abdominal,  33 
baby’s,  128 
obstetric,  210 
Birth,  preparation  for,  200 
Bladder,  58,  206 
Blankets,  41,  200 
Bleeding,  180 
Blood,  12 
Bodies,  11,  64 
Body,  11,  15,  84 
Boiled  water,  136,  180 
Boils,  236 
Books,  162 

Boracic  acid,  35,  156,  220 
Borax,  34,  53,  148 
Bottle,  baby’s,  148 
care  of,  148 
feeding,  143 
medicine,  121 
milk,  72 
nursing,  148 

Bowels,  92,  104,  143,  212,  228 


272 


INDEX 


Breasts,  205 
Breath,  24 
Breathing,  58,  88 
Bronchitis,  238 
Broths,  68 
Burns,  182 

C 

Canned  goods,  188 
Capsules,  124 
Castor  oil,  34,  188 
Cathartics,  34 
Catheter,  204,  210,  225 
Chair,  60 
Changing  bed,  43 
gown,  52 
pillow,  45 
Charts,  87 
Chills,  93 

Cleanliness,  57,  78,  209 
Clothing,  129 
Coffee,  66,  69 
Colic,  137 
Comfort,  38 
of  patients,  56 
Compress,  107,  109,  116 
Constipation,  197,  242 
Contagion,  163 
Contagious  disease,  162 
Convalescents,  77 
Convulsions,  242 
Cookery,  invalid,  253 
Cotton,  116,  201 
Cough,  161,  165,  238 
Croup,  240 
tent,  241 
Cry  of  baby,  136 
Cuts,  179 

D 

Delirious  patients,  57,  60 
Diarrhea,  68,  197,  239 


Diapers,  149 

Diet,  176,  213,  231,  239,  250 
Digestive  fluids,  65 
organs,  14 
trouble,  14 
Diphtheria,  16,  237 
Disease,  11,  25,  47,  93 
communicable,  159 
germs  of,  15,  161 
infectious,  161 
spread  of,  16 

Disinfectants,  18,  25,  47,  93, 
151,  161 
chemical,  19 
natural,  19 
solution,  25 
Disinfection,  157 
of  clothing,  152 
of  hands,  180 
of  room,  153,  164 
of  utensils,  152 
Doses,  120,  123 
Douche,  204,  226 
Scotch,  101 
vaginal,  226 
Draw  sheets,  40 
Dressings,  182,  205 
Drowning,  183 
Drugs,  34,  35,  137 
Dust,  17,  25,  168 
Dusting,  25 
Dyspepsia,  14 

E 

Ear,  95 
Eczema,  233 
Egg,  69 

white  of,  107 
Eggs,  14,  69,  188,  250 
P]ll)ow,  176 
Emergencies,  179 
Emetics,  187 


INDEX 


273 


Enema,  104,  106 
Erysipelas,  237 
Examination,  230 
Exercise,  13,  139,  244 
Excoriation,  59 
Excreta,  155,  156 
Expectoration,  162 
Eye,  93,  95,  220 
accidents,  185 
bath,  116 
compresses,  108 
infection  of,  220 
inflammation  of,  108 
Eyelids,  131,  220 

F 

Face,  48 
Fainting,  185 
Fats,  14,  64 
Feeding,  76 
artificial,  142 
cups,  33,  82 
of  baby,  138 
principles  of,  85 
in  sickness,  76 
typhoid  fever,  76 
Feet,  57,  62 
Fever,  69,  84 
diet  in,  65 
symptoms,  84 
Filter,  20 

Flaxseed  lemonade,  253 
poultice,  112 
Flies,  17,  22,  28,  140 
Fomentations,  32,  114 
Food,  13,  14,  64 

administration  of,  65 
amount  of,  79 
care  of,  70 
chewing  of,  14 
cooking  of,  77 
for  children,  145 
18 


Food  for  infants,  143 
milk  as,  14 
serving  of,  77 
Foreign  bodies,  185 
Formaldehyde,  153 
Fractures,  186 
Fresh  air,  149,  248 
Frost  bites,  183 
Fruits,  244 
Fumigation,  153 

G 

Gargle,  35,  242 
Gas,  poisoning  by,  188 
Gauze,  107,  108,  116 
Gelatin,  68 

Germs,  18,  70,  162,  168 
Glass,  medicine,  120 
Groin,  137 

H 

Hair,  combing  of,  49,  53 
disinfection  of,  161 
vermin  in,  54 
Hand,  176 
Hands,  48,  181,  203 
disinfection  of,  203 
in  typhoid  fever,  229 
Head,  47,  58 
bandage  for,  176 
Health,  11,  15,  21 
Heart,  89 
Heat,  33,  100,  152 
Hemorrhage,  184,  245 
Hives,  235 
Hot  air,  110 

fomentations,  114 
water  bottles,  57,  62 
Hygiene,  249 

Hypodermic  injection,  125 


274 


INDEX 


I 

Ice,  19 

boxes,  71 
cap,  108,  109,  121 
poultice,  108 
Infant,  215 
air  for,  217 
bathing  of,  216 
care  of,  217 
Infection,  19,  160,  202 
Isolation,  159 
Itch,  235 

K 

Kidney,  19 
Knees,  100,  105 

L 

Labels,  121 
Labor,  202 
Lard,  116 
Laudanum,  115 
Laxative,  34 
Leg,  43 

Lime,  155,  186 
Lips,  53 
Lungs,  19 

M 

Mattress,  38,  132 
Measles,  238,  239 
Medicines,  50 
fluid,  120 
giving  of,  120 
sleep-producing,  122 
Meat,  198 
Milk,  65,  214 
as  a food,  66 
germs  in,  67,  70 
modification  of,  66,  143 
pasteurization  of,  67,  142 


Milk,  predigestion  of,  68 
sterilization,  68,  142 
Morning  care,  48 
Mosquitoes,  17 
Mouth,  14 
breathing,  94 
cleansing  of,  52,  131 
in  typhoid  fever,  53 
washes,  53 
Mustard,  34,  242 

N 

Nails,  care  of,  52,  181 
Neatness,  209 
Nose,  14,  94 
hemorrhage  from,  184 
Nurse,  27 

Nursing,  good,  26,  250 
in  diphtheria,  237 
maternity,  207 
pneumonia,  232 
typhoid  fever,  228 
tuberculosis,  246 
in  other  people's  homes, 
250 

O 

Oil,  124 
carron,  183 
castor,  34,  124 
olive,  34,  107,  201 
Opium,  137 

P 

Packs,  100,  109 
cold,  100 

hot,  101,  109,  183 
Pads,  201 
Pain,  84,  91 
Pasteurization,  67 
Patient,  82,  98,  100,  105,  161 
Peroxide  of  hydrogen,  35,  157 


INDEX 


275 


Pickles,  77 

Pillows,  33,  42,  44,  57 
Pills,  34,  123 
Pneumonia,  232 
Poison  ivy,  237 
Poisoning,  187,  188 
by  food,  187 
by  gas,  188 

Position  of  patient,  80,  91 
Poultice,  112,  122 
bran,  114 
bread,  113 
flaxseed,  112 
hop,  114 
icQ,  108 
mustard,  107 
starch,  114 
Powders,  123 
Pulse,  84,  88 
Purgative  enema,  104 

Q 

Quarantine,  159 

R 

Records,  96 
Recreation,  13 
Recipes,  253 
Rectal  irrigation,  104 
tube,  105 
Rectum,  105 
Relapses,  230 
Respiration,  88 
artificial,  183 
Rest,  13,  47,  247 
Room,  21,  160,  202 
Rub,  salt,  102 
Rubber  cushions,  61 
sheet,  31 
tubing,  30 
Rubbing,  224 


S 

Saliva,  66 
Salt,  67 
rub,  162 
solution,  105 
Salts,  Epsom,  34 
Scalp,  bandage  for,  176 
Scarlet  fever,  20,  159 
Screen,  24,  33 
Shock,  184 
Sickness,  11,  19,  30 
Sickroom,  21 
Skin,  47,  234 
diseases,  234 
Sleep,  132,  149,  218 
Sleeplessness,  224 
Sling,  175 
Slops,  25 
Soap,  105 

Soda  bicarbonate,  67 
water,  67 
Solution,  61,  105 
bichloride,  203 
disinfectant,  25 
salt,  156,  181 
Sponge  bath,  98 
Sprains,  183 
Sputum,  166 
Stimulation,  105 
Stomach,  66 
infant’s,  136 
Stools,  229 
Stupe,  115 
Sulphur,  154 
Sunshine,  12 
Sunstroke,  185 
Support,  43 
Sweeping,  22 
Symptoms,  84 
Syringe,  fountain,  30,  105 
hypodermic,  125 
Sweat,  109 


270 


INDEX 


T 

Tablets,  122 
Tea,  78 
Teeth,  53 
Teething,  138 
Temperature,  85 
charts,  87 
of  food,  79 
patient’s,  85 
of  room,  25 
recording  of,  87 
Tent,  250 
Thermometer,  85 
Toast,  78 
Tray,  32 
Tube,  82 

Tuberculosis,  165,  246 
Turpentine  34,  116 
Typhoid  fever,  159,  228,  230 
diet  in,  231 
nursing  in,  228 

U 

Ulceration,  228 
Urine,  92,  199 
amount  of,  92 


Urine,  retention  of,  224 
specimen  of,  93 
Utensils,  152,  229 

V 

Vaseline,  35,  107 
Vegetable,  19,  64,  77 
Ventilation,  24 
Vermin,  38,  54 
Vinegar,  35,  54 
Vomiting,  107 

w 

Waste,  11,  65 
Water,  14,  24 
boiled,  203 
drinking,  18 
for  babies,  136 
necessity  of,  65 
oatmeal,  145 
uses  of,  98 
Weight,  213 
Womb,  204,  208 
Wound,  62,  179 
bleeding  from,  180 


Books  for  Nurses 

PUBLISHED  BY 

W.  B.  SAUNDERS  COMPANY 

West  Washington  Square  Philadelphia 

London:  9,  Henrietta  Street,  Covent  Garden 


Sanders’  Nursing  A NEW  WORK 

Miss  Sanders’  new  book  is  undoubtedly  the  most 
complete  and  most  practical  work  on  nursing  ever 
p iblished.  Everything  about  every  subject  with 
which  the  nurse  should  be  familiar  is  detailed  in 
a clean  cut,  definite  way.  There  is  no  other 
nursing  book  so  full  of  good,  practical  informa- 
tion— information  you  need. 

Modern  Methods  in  Nursing.  By  Georgiana  J.  Sanders, 
formerly  Superintendent  of  Nurses  at  Massachusetts  Gen- 
eral Hospital.  i2mo  of  88i  pages,  with  227  illustrations. 

Cloth,  $2.50  net. 

Aikens’  Home  Nurse’s  Handbook 

PRACTICAL 

The  point  about  this  work  is  this:  It  tells  you, 

and  shows  you  just  how  to  do  those  little — but 
none  the  less  important — things  entirely  omitted 
from  other  nursing  books,  or  at  best  only  inci- 
dentally treated.  The  chapters  on  “Home  Treat- 
ments” and  “Every-Day  Care  of  the  Baby,” 
stand  out  as  particularly  practical.  Then  the 
'‘Points  to  be  Remembered” — terse,  crisp  re- 
minders— is  a feature  of  great  value. 

Home  Nurse’s  Handbook.  By  Charlotte  A.  Aikens, 
formerly  Director  of  the  Sibley  Memorial  Hospital,  Wash- 
ington, D.C.  i2mo  of  276  pages,  illustrated.  Cloth,  $1.50  nei 


NEW  (4th)  EDITION 


Stoney’s  Nursing 


Of  this  work  the  American  Jour7ial  of  Nursing  says:  ‘‘It  is  the 
fullest  and  most  complete  and  may  well  be  recommended  as 
being  of  great  general  usefulness.  The  best  chapter  is  the  one 
on  observation  of  symptoms  which  is  very  thorough.’’  There 
are  directions  how  to  improvise  everything. 

Practical  Points  in  Nursing.  By  Emily  M.  A.  Stoney,  formerly  Super- 
intendent of  the  Training  School  for  Nurses  in  the  Carney  Hospital, 
South  Boston,  Mass,  lamo,  495  pages,  illustrated.  Cloth,  $1.75  net. 


Stoney’s  Materia  Medica 


NEW  (3d)  EDITION 


Stoney’s  Materia  Medica  was  written  by  a head  nurse  who 
knows  just  what  the  nurse  needs.  American  Medicine  says 
it  contains  ‘‘all  the  information  in  regards  to  drugs  that  a 
nurse  should  possess.” 

Materia  Medica  for  Nurses.  By  Emily  M.  A.  Stoney,  formerly  Super- 
intendent of  the  Training  School  for  Nurses  in  the  Carney  Hospital, 
South  Boston,  Mass.  lamo  volume  of  300  pages.  Cloth,  $1.50  net. 


Stoney’s  Surgical  Technic  NEW  (3d)  EDITION 

The  first  part  of  the  book  is  dovoted  to  Bacteriology  and 
Antiseptics;  the  second  part  to  Surgical  Technic,  Signs  of 
Death,  Bandaging,  Care  of  Infants,  etc. 

Bacteriology  and  Surgical  Technic  for  Nurses.  By  Emily  M.  A. 
^ Stoney.  Revised  by  Frederic  R.  Griffith,  M.  D.,  New  York. 

i2mo  volume  of  311  pages,  fully  illustrated.  Cloth,  $1.50  net. 

Goodnow’s  First- Year  Nursing  ILLUSTRATED 

Miss  Goodnow’s  work  deals  entirely  with  the  practical  side  of 
first-year  nursing  work.  It  is  the  application  of  text-book 
knowledge.  It  tells  the  nurse  hoiu  to  do  those  things  she  is  called 
upon  to  do  in  her  first  year  in  the  training  school — the  actual 
ward  work, 

First-Year  Nursing.  By  Minnie  Goodnow,  R.  N.,  formerly  Super- 
intendent of  the  Women's  Hospital,  Denver.  lamo  of  328  pages, 

illustrated.  Cloth,  $1.50  net. 


Aikens’  Hospital  Management 

This  is  just  the  work  for  hospital  superintendents,  training- 
school  principals,  ph}^sicians,  and  all  who  are  actively  inter- 
ested in  hospital  administration.  The  Medical  Record  sa3^s: 
“Tells  in  concise  form  exactly  what  a hospital  should  do 
and  how  it  should  be  run,  from  the  scrubwoman  up  to  its 
financing.  “ 

Hospital  Management.  Arranged  and  edited  by  Charlotte  A. 
Aikens,  formerly  Director  Sibley  Memorial  Hospital,  Washing- 
ton, D.  C.  i2mo  of  488  pages,  illustrated.  Cloth,  $3.00  net 


Aikens’  Primary  Studies  NEW  (2d)  EDITION 

Trained  Nurse  and  Hospital  Review  says:  “It  is  safe  to  say 
that  any  pupil  who  has  mastered  even  the  major  portion  of 
this  work  would  be  one  of  the  best  prepared  first  year  pupils 
who  ever  stood  for  examination.’’ 

Primary  Studies  for  Nurses.  By  Charlotte  A.  Aikens,  formerly 
Director  of  Sibley  Memorial  Hospital,  Washington,  D.  C.  i2mo  of 
437  pages,  illustrated.  Cloth,  $1.75  net. 

Aikens’  Training-School  Methods  and 
the  Head  Nurse 

This  work  not  only  tells  how  to  teach,  but  also  what  should 
be  taught  the  nurse  and  how  much.  The  Medical  Record  says: 
“ This  book  is  original,  breezy  and  healthy.” 

Hospital  Training-School  Methods  and  the  Head  Nurse.  By  CHAR- 
LOTTE A.  Aikens,  formerly  Director  of  Sibley  Memorial  Hospital, 
Washington,  D.  C.  i2me  of  267  pages.  Cloth,  $1.50  net 


Aikens’  Clinical  Studies 


NEW  (2d)  EDITION 


This  work  for  second  and  third  year  students  is  written  on  the 
same  lines  as  the  author’s  successful  work  for  primary  stu- 
dents. Dietetic  and  Hygieiiic  Gazette  sdcys  there  “ is  a large 
amount  of  practical  information  in  this  book.” 

Clinical  Studies  for  Nurses.  By  Charlotte  A.  Aikens,  formerly 
Director  of  Sibley  Memorial  Hospital,  Washington,  D.  C.  i2mo  of 
569  pages,  illustrated  Cloth,  $2.00  net 


3 


Bolduan  and  Grund’s  Bacteriology 

The  authors  have  laid  particular  emphasis  on  the  immediate 
application  of  bacteriology  to  the  art  of  nursing.  It  is  an 
applied  bacteriology  in  the  truest  sense,  A study  of  all  the 
ordinary  modes  of  transmission  of  infection  are  included. 

Applied  Bacteriology  for  Nurses.  By  Charles  F.  Bolduan,  M.  D., 
Assistant  to  the  General  Medical  Officer,  and  Marie  Grund,  M.D., 
Bacteriologist,  Research  Laboratory,  Department  of  Health,  City  of 
New  York.  i2mo  of  i66  pages,  illustrated.  Cloth,  $1.25  net. 

Fiske’s  The  Body  A NEW  IDEA 

Trained  Nurse  and  Hospital  Review  says  *4t  is  concise,  well- 
written  and  well  illustrated,  and  should  meet  with  favor  in 
schools  for  nurses  and  with  the  graduate  nurse.’' 

Structure  and  Functions  of  the  Body.  By  Annette  Fiske,  A.  M., 
Graduate  of  the  Waltham  Training  School  for  Nurses,  Massa- 
chusetts. i2mo  of  221  pages,  illustrated.  Cloth,  $1.25  net 

Beck’s  Reference  Handbook  NEW  (3d)  EDITION 

This  book  contains  all  the  information  that  a nurse  requires 
to  carry  out  any  directions  given  by  the  physician.  The 
Mo7itreal  Medical  Journal  says  it  is  “ cleverly  systematized  and 
shows  close  observation  of  the  sickroom  and  hospital  regime.” 

A Reference  Handbook  for  Nurses.  By  Amanda  K.  Beck,  Grad- 
uate of  the  Illinois  Training  School  for  Nurses,  Chicago.  Ill* 
32mo  volume  of  244  pages.  Bound  in  flexible  leather,  $1.25  net. 

Roberts’  Bacteriology  & Pathology 

This  new  work  is  practical  in  the  strictest  sense.  Written 
specially  for  nurses,  it  confines  itself  to  information  that  the 
nurse  should  know.  All  unessential  matter  is  excluded.  The 
style  is  concise  and  to  the  point,  }^et  clear  and  plain.  The  text 
is  illustrated  throughout. 

Bacteriology  and  Pathofogy  for  Nurses.  By  Jay  G.  Roberts,  Ph.  G., 
M.  D.,  Oskaloosa,  Iowa.  i2mo  of  206  pages,  illustrated.  $1.25  net. 


DeLee’s  Obstetrics  for  Nurses  EDITION 

Dr.  DeDee^s  book  really  considers  two  subjects — obstetrics 
for  nurses  and  actual  obstetric  nursing.  Tramed  Nurse  and 
Hospital  Review  says  the  “book  abounds  with  practical 
suggestions,  and  they  are  given  with  such  clearness  that 
they  cannot  fail  to  leave  their  impress.  “ 

Obstetrics  for  Nurses.  By  Joseph  B.  DeLee,  M.  D.,  Professor  of 
Obstetrics  at  the  Northwestern  University  Medical  School,  Chicago. 
i2mo  volume  of  508  pages,  fully  illustrated.  Cloth,  $2.50  net. 

Davis’  Obstetric  & Gynecologic  Nursing 

NEW  (4th)  EDITION 

The  Trained  Nurse  and  Hospital  Review  says:  “ This  is  one 
of  the  most  practical  and  useful  books  ever  presented  to  the 
nursing  profes.sion . “ The  text  is  illustrated. 

Obstetric  and  Gynecologic  Nursing.  By  Edward  P.  Davis,  M.  D., 
Professor  of  Obstetrics  in  the  Jefferson  Medical  College,  Philadel- 
phia. i-2mo  volume  of  480  pages,  illustrated.  Buckram,  $1.75  net. 

Macfarlane’s  Gynecology  for  Nurses 

JUST  READY— NEW  (2d)  EDITION 

Dr,  A,  M,  Seabrook,  Woman’s  Hospital  of  Philadelphia,  says: 
“It  is  a most  admirable  little  book,  covering  in  a concise  but 
attractive  way  the  subject  from  the  nurse’s  standpoint.  You 
certainly  keep  up  to  date  in  all  these  matters,  and  are  to  be 
complimented  upon  your  progress  and  enterprise.’’ 

A Reference  Handbook  of  Gynecology  for  Nurses.  By  Catharine 
Macfarlane,  M.  D.,  Gynecologist  to  the  Woman’s  Hospital  of  Phil- 
adelphia. 32mo  of  156  pages,  with  70  illustrations.  Flexible  leather, 
$1.25  net. 


McKenzie’s  Exercise  in  Education  and  Medicine 

Exercise  in  Education  and  Medicine.  By  R.  Tait 
McKknzik,  B.A.,  M.D.,  Professor  of  Physical  Educa- 
tion, and  Director  of  the  Department,  University  of 
Pennsylvania.  Octavo  of  406  pages,  with  346  illustra- 
tions. Cloth,  J3.50  net. 


5 


Bohm  & Painter’s  Massage  rS 

The  methods  described  are  those  employed  in  Holla's  Clinic 
— methods  that  give  results.  Every  step  is  illustrated,  showing 
you  the  exact  direction  of  the  strokings.  The  pictures  are 
large. 

Octavo  of  Qi  pages,  with  q?  illustrations.  By  Max  Bohm,  M.  D., 
Berlin,  Germany.  Edited  by  Charles  F.  Painter,  M.  D.,  Professor 
of  Orthopedic  Surgery,  Tufts  College  Medical  School,  Boston. 

Cloth,  $1.75  net. 

Eye,  Ear,  Nose,  and  Throat  Nursing 

Medical  Record  says:  ‘‘Every  side  of  the  question  has  been 
fully  taken  into  consideration.” 

Nursing  in  Diseases  of  the  Eye,  Ear.  Nose  and  Throat.  By  the 
Committee  on  Nurses  of  the  Manhattan  Eye,  Ear  and  Throat  Hospital. 
i2mo  of  260  pages,  illustrated.  Cloth,  $1.50  net. 

Friedenwald  and  Ruhrah’s  Dietetics  for 


N urses  JUST  READY— NEW  (3d)  EDITION 

This  work  has  been  prepared  to  meet  the  needs  of  the  nurse, 
both  in  training  school  and  after  graduation.  American  Jour- 
nal of  Nursing  says  it  “is  exactly  the  book  for  which  nurses 
and  others  have  long  and  vainh^  sought.” 


Dietetics  for  Nurses.  By  Julius  Friedenvvald,  M.  D.,  Professor 
of  Diseases  of  the  Stomach,  and  John  Ruhrah,  M.  D.,  Professor  of 
Diseases  of  Children,  College  of  Physicians  and  Surgeons,  Baltimore. 
i2mo  volume  of  431  pages.  Cloth,  $1.50  net 


Friedenwald  & Ruhrah  on  Diet  EDITION 


Diet  in  Health  and  Disease.  By  Jumus  Frikden- 
WAED,  M.D.,  and  John  Ruhrah,  M.D.  Octavo  vol- 
ume of  857  pages.  Cloth,  $4.00  net. 


Galbraith’s  Personal  Hygiene  and  Physical 

Training  for  Women  ILLUSTRATED 

Personal  Hygiene  and  Physical  Training  for  Women.  By  Anna  M. 
Galbraith,  M.  D.,  Fellow  New  York  Academy  of  Medicine.  i2mo 
of  371  pages,  illustrated.  Cloth,  $2.00  net. 

Galbraith’s  Four  Epochs  of  Woman’s  Life 

THE  NEW  (2d)  EDITION 

The  Four  Epochs  of  Woman’s  Life.  Bv  Anna  M.  Galbraith,  M.D. 
With  an  Introductory  Note  by  John  H.  Musser,  M.  D.,  University 
of  Pennsylvania,  lamo  of  247  pages.  Cloth,  $1.50  net 


6 


McCombs’  Diseases  of  Children  for  Nurses 

NEW  (2d)  EDITION 

Dr.  McCombs^  experience  in  lecturing  to  nurses  has  enabled 
him  to  emphasize  jtist  those  points  that  ?iurses  7nost  7ieed  to  know. 
National  Hospital  Record  says:  ‘‘We  have  needed  a good 

book  on  children’s  diseases  and  this  volume  admirably  fills 
the  want.”  The  nurse’s  side  has  been  written  by  head 
nurses,  very  valuable  being  the  work  of  Miss  Jennie  Manly. 

Diseases  of  Children  for  Nurses.  By  Robert  S.  McCombs,  M.  D., 
Instructor  of  Nurses  at  the  Children’s  Hospital  of  Philadelphia.  12010 
of  470  pages,  illustrated.  Cloth,  $2.00  net 

Wilson’s  Obstetric  Nursing  NEW  (2d)  EDITION 

In  Dr.  Wilson’s  work  the  entire  subject  is  covered  from  the 
beginning  of  pregnancy,  its  course,  signs,  labor,  its  actual 
accomplishment,  the  puerperium  and  care  of  the  infant. 
American  Journal  of  Obstetrics  “ Every  page  empasizes 

the  nurse’s  relation  to  the  case.” 

A Reference  Handbook  of  Obstetric  Nursing.  By  W.  Reynolds 
Wilson,  M.D.,  Visiting  Physician  to  the  Philadelphia  Lying-in  Char- 
tty,  32mo  of  355  pages,  illustrated.  Flexible  leather,  $1.25  net 

American  Pocket  Dictionary  NEW  (8th)  EDITION 

The  Tramed  Nurse  a7id  Hospital  Review  says:  “We  have 

had  many  occasions  to  refer  to  this  dictionary,  and  in  every 
instance  we  have  found  the  desired  information.” 

American  Pocket  Medical  Dictionary.  Edited  by  W.  A.  NewmaN 
Dorland,  a.  M.,  M.  D.,  Loyola  University,  Chicago.  Flexible 
leather,  gold  edges,  $1.00  net;  with  patent  thumb  index,  $1.25  net 

Lewis’  Anatomy  and  Physiology  eomoN 

Nurses  Journal  of  Pacific  Coast  says  “it  is  not  in  any  sense 
rudimentary,  but  comprehensive  in  its  treatment  of  the  sub- 
jects.” The  low  price  makes  this  book  particularly  attractive. 

Anatomy  and  Physiology  for  Nurses.  By  LeRoy  Lewis,  M.D.,  Lec- 
turer on  Anatomy  and  Physiology  for  Nurses,  Lewis  Hospital,  Bay 
City,  Mich.  i2mo  of  326  pages,  150  illustrations.  Cloth,  $1.75  net 


Boyd’s  State  Registration  for  Nurses 

State  Registration  for  Nurses.  By  Louie  CrofT  Boyd,  R.  N.,  Grad- 
uate Colorado  Training  School  for  Nurses.  Price,  50  cents  net. 


Paul’s  Materia  Medica 


NEW  (2d)  EDITION 


A Text-Book  of  Materia  Medica  for  Nurses.  By  George  P.  Paul,  M.D., 
Samaritan  Hospital,  Troy,  N.  Y.  i2mo  of  282  pages.  Cloth,  $1.50  net. 


Paul’s 


Fever  Nursing 

Nursing  in  the  Acute  Infectious  Fevers. 
i2mo  of  246  pages,  illustrated. 


NEW  (2d)  EDITION 

By  George  P.  Paul,  M.D. 

Cloth,  $i.cx)net. 


Hoxie  & Laptad’s  Medicine  for  Nurses 

JUST  READY— NEW  (2d)  EDITION,  REWRITTEN 

Medicine  for  Nurses  and  Housemothers.  By  George  Howard 
Hoxie,  M.D.,  University  of  Kansas;  and  Pearl  L.  Laptad.  i2mo 
of  351  pages,  illustrated.  Cloth,  $1.50  net. 


Grafstrom’s  Mechano-therapy 


SECOND 

EDITION 


Mechano-therapy  (Massage  and  Medical  Gymnastics).  By  AXEL  V, 
Grafstrom,  B.Sc.  M.D.,  i2mo,  200  pages.  Cloth,  $12^  net. 


Nancrede’s  Anatomy  NEW  (7th)  EDITION 

Essentials  of  Anatomy.  Charles  B.  G.  deNancrede,  M.D.,  Univers- 
ity of  Michigan.  i2mo,  400  pages,  180  illustrations.  Cloth,  $1.00  net 


Morrow’s  Immediate  Care  of  Injured 

Immediate  Care  of  the  Injurei.  By  Albert  S.  Morrow,  M.D.,  New 
York  City  Home  for  Aged  and  Infirm.  Octavo  of  354  pages,  with 
242  illustrations.  Cloth,  $2.50  net.  New  (2d)  Edition 

Register’s  Fever  Nursing 

A Text  Book  on  Practical  Fever  Nu-sing.  By  Edward  C.  Register, 
M.D.,  North  Carolina  Medical  ColK'ge.  Octavo  of  350  pages,  illus- 
trated. (-loth,  $2. so  net. 


Pyle’s  Personal  Hygiene  NEW  (5th)  EDITION 

A Manual  of  Personal  Hygiene.  Edited  by  Walter  L.  Pyi,e,  M.D. 
Wills  Eye  Hospital,  Philadelphia.  i2mo,  |xs  pages,  illus.  $1.50  net. 


Morris’  Materia  Medica 


NEW  (7th)  EDITION 


Essentials  of  Materia  Medica,  Therapeutics,  and  Prescription  Writing. 
By  Henry  Morris.  M.D.  Revised  by  W.  A.  Bastedo,  M.D.,  Colum- 
bia University,  N.  Y.  i2mo  of  300  pages,  illustrated.  Cloth,  $1.00  net. 


Griffith’s  Care  of  the  Baby  NEW  (5th)  EDITION 

The  Care  of  the  Baby.  By  J.  P.  Crozer  Griffith,  M.D.,  Univers- 
ity of  Pennsylvania.  i2mo  of  455  pages,  illustrated.  Cloth,  $1.50  net. 


8 


